Archived: Tor Vale Nursing Home

Updated 29 June 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection visit took place on 3 May 2016 and was unannounced. One social care inspector carried out this inspection.

Before our inspection, we reviewed the information we held about the home, which included incident notifications they had sent us. A notification is information about important events which the service is required to tell us about by law.

The people living at the home had a learning disability and had limited communication abilities. They were unable to share their experiences with us. During our inspection we met and spent time with all five of the people living in the home. We spent time in the lounge observing staff interactions with people and saw how people spent their time. We used the principles of the Short Observational Framework for Inspection (SOFI) in our observations. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

During our inspection we spoke with three care staff, a nurse and the registered manager as well as two relatives on the telephone. We received feedback from a physiotherapist who visited the home at the time of our visit, as well as a healthcare professional who contacted us following the inspection. We looked at two people’s care plans, the medicine records, three staff recruitment and training files as well as records of internal audits and those related to the management of the home.

Updated 29 June 2016

Tor Vale is a purpose-built home for five people with profound learning and physical disability that is registered for nursing care. It is owned and managed by The Durnford Society Limited who run a number of care services for people with learning disabilities. At the time of the inspection five people were living at the 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”.