Archived: Tor Vale Nursing Home

This inspection was unannounced and took place on 3 May 2016. At our last inspection in July 2014 we did not identify any concerns.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

All those living at Tor Vale had a learning disability and varying communication abilities. Some people were able to say, “yes” and nod their head when we asked if they were happy living at the home, while others were unable to share with us their experiences. As people could not tell us in detail about their care, we observed their interactions with the staff. People were happy for staff to take their hands, they made eye contact and smiled at the staff. This indicated people felt safe and comfortable in the home. Relatives told us they were confident with the care their relations were receiving and they had no concerns.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People’s capacity had been assessed in relation to a number of decisions about their care and welfare, such as taking prescribed medicines, the use of monitoring equipment and financial expenditure. However some assessments had not been fully completed. One person had not had a capacity assessment or best interest decision recorded for treatment recommended after a routine health check-up. The registered manager confirmed they would review the home’s documentation in relation to these assessments.

Some people were at risk of not eating or drinking enough to maintain their health. Healthcare professionals were involved in assessing people’s needs and providing guidance to staff. However, one healthcare professional raised a concern with us that staff had not followed their advice about when to record a person’s weight to ensure this was recorded as accurately as possible. Also records were not completed in a way that allowed staff to know how much people were drinking.

We recommend the service reviews the way in which people’s diet and fluid intake is recorded, monitored and managed.

Staff had received training in safeguarding people and knew what to do if they suspected abuse. Posters with contact details for reporting any issues of concern directly to the local authority’s safeguarding team were on display. A recent safeguarding incident had been appropriately reported to the local authority’s safeguarding team and CQC. Staff were confident any concerns regarding people’s safety and welfare would be investigated. One staff member said, “nothing would be ignored”. Staff looked out for signs people may have concerns or may not be happy, as many of the people living at the home would not be able to express this.

Risks to people’s health and safety were assessed and management plans were in place to reduce these risks. Assessments included risks to people from poor mobility, swallowing difficulties and health issues. Staff were provided with clear instructions about how to meet people’s needs safely. People had access to healthcare services when they needed them and guidance was sought from specialist health care professionals where necessary. People received their medicines safely and as prescribed. All staff were trained in the safe administration of medicines although only the nurses administered medicines in the home.

People were supported by sufficient numbers of safely recruited and well trained staff. During the inspection we saw staff spending time with people, supporting them with personal care, eating and drinking and with activities. Staff told us the staffing arrangements varied throughout the week dependent on what community activities people attended. Staff said they received the training necessary to carry out their duties safely and to understand people’s care needs. Staff were knowledgeable about the people they supported and were able to describe to us their needs and preferences. Each person had a care file that provided clear information about people’s care and support needs. People were supported to maintain a healthy diet and staff were knowledgeable about what food they liked and how to support them to eat and drink well.

People had a named nurse and a ‘keyworker’ care staff who were responsible for ensuring they received the care and support they needed, were supported with meaningful leisure and social activities, and who communicated with their families. People were encouraged to be involved in a variety of activities both in and out of the home and to maintain contact with their families. One relative said their relation’s health and well-being had improved significantly since moving to the home. They described the staff as “marvellous”.

As Tor Vale provided nursing care, the home was able to support people should their health decline and they require ‘end of life’ care. The nurses worked closely with the local hospice to ensure their clinical skills remained up to date and they were able to continue to care and support people through ill health.

The home had effective systems in place to assess people’s needs, recruit and train staff and to monitor the quality of the support services they provided. Staff told us the home was well managed and they enjoyed working at Tor Vale. One staff member said, “It’s a nice place to work, I like it here” and another said, “I really like working here, we’re a good team”.

This inspection was carried out by one inspector over two days. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with the staff who were supporting the people who lived at Tor Vale and from looking at records. We also met with the Chief Executive of the Durnford Society.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We judged the service to be safe on the days of our inspection.

The people who lived at the home were observed to receive continuous care and attention from the staff team. They appeared happy at the home, and nobody was unkind to them.

The home provided a good standard of accommodation which was clean and well maintained.

We inspected the staff rotas which showed there were sufficient staff on duty to meet people's needs throughout the day and night. People were observed to receive a consistent and safe level of support.

Tor Vale alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Tor Vale had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). This helped to ensure that people's needs were met.

We inspected the personal finances of the people at Tor Vale in response to concerns notified to us. Following a full audit of peoples' finances we found that balances of money held by the home were correct. Procedures and systems to ensure the safekeeping of peoples' money were in place.

Is the service effective?

We judged the service to be effective on the days of our inspection.

Individual care plans were in place. Care plans contained satisfactory information and were accessible.

There was suitable access to doctors, specialist nurses, chiropodists and opticians.

People's health and care needs were assessed with them, and people were involved in reviewing their plans of care if they had the capacity to do so. During our inspection it was clear from our observations and from speaking with staff that they had a good understanding of people's needs.

Specialist dietary needs had been identified where required. Care plans were up-to-date.

We saw that there was good liaison and communication with other professionals and agencies to ensure people's care needs were met.

The quality of recording seen was of a good standard enabling nurses and care staff to use the information correctly.

Is the service caring?

We judged the service was caring on the days of our inspection.

Our observations of the care provided, discussions with staff and records we looked at enabled us to conclude that individual wishes regarding people's care and support were taken into account and respected.

From discussion with the staff, it was clear they understood the people's needs well. We were told the registered manager did their best to ensure the people were well cared for, and promoted people to have suitable opportunities and choices.

We saw activities were provided for the people who used the service. For example Tor Vale had a mini bus and frequent trips and holidays arranged.

People's preferences and interests had been recorded and life histories were evident.

Tor Vale had regular support from the local GP practices and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive?

We judged the service was responsive on the days of our inspection.

The people who lived at Tor Vale had complex health and care needs and were either not able, or chose not to join in group activities. The care records showed evidence of the lifestyle of these people and we observed that staff spent one-to-one time with people throughout the day.

The service worked well with other agencies and services to make sure people received care in a coherent way.

From discussion with the staff, and from inspection of records we judged there were suitable links with local health services. Records showed there was appropriate contact with medical professionals.

Is the service well-led?

We judged the service to be well led on the days of our inspection

The staff told us that regular staff meetings were held. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service.

The service had a quality assurance system, and staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

From discussion with the registered provider and manager we judged they understood the people's needs and met these appropriately. There were systems to monitor the people's care co-ordinated by the local authority.

We met and spoke to all four people who used the service and spoke to all the staff on duty about the care given. We looked at the care records of two people who used the service. We looked at other records and observed staff working with people. We also spoke with the registered manager, the Chairman of Durnford Society (The Company that own Tor Vale) and the nominated individual. We saw staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We saw that the staff had a good understanding of people's individual needs and that they respected people's privacy and dignity.

We saw staff received the training they required to carry out their roles and all staff spoken with agreed that they felt supported by the manager.

We saw that people's individual support plans described their needs and how people liked those needs to be meet. We saw records that showed that a multi-agency meeting had taken place to discuss if a medical procedure was in a person's best interest.

We saw that medication was administered by the qualified nurses who worked at the home. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to administer and record medication.

We saw that Tor Vale Nursing Home held all records securely to protect people's confidentiality.

We met all four people who used services, spoke with one trainee health care worker who was visiting the home, talked with six staff and checked the provider's records. We spoke to staff about the care given, looked at the care records of two people; we met them, looked at records and observed staff working with them. The qualified staff in charge also provided information.

We saw that staff treated people with consideration and respect. For example, we saw that staff responded to people's care needs to ensure that they were kept comfortable and informed about what was happening, such as discreetly assisting people with eating their lunch.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. They demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have.

One compliment letter sent to the home said, 'How pleased we are as a family with the care our relative is receiving at Tor Vale"'.