Torwoodhall Care Home Service Adults Carronvale Road Larbert FK5 3LG Telephone:

Torwoodhall Care Home Service Adults Carronvale Road Larbert FK5 3LG Telephone: 01324 503490 Inspected by: Lesley Greig Andrea Daley Type of inspection: Unannounced Inspection completed on: 6 March 2012

Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 6 3 The inspection 10 4 Other information 19 5 Summary of grades 20 6 Inspection and grading history 20 Service provided by: Falkirk Council Service provider number: SP2004006884 Care service number: CS2003011557 Contact details for the inspector who inspected this service: Lesley Greig Telephone 01786 406363 Email enquiries@scswis.com Torwoodhall, page 2 of 22

Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 4 Good Quality of Environment Quality of Staffing N/A N/A Quality of Management and Leadership 4 Good What the service does well The service continues to work in partnership with a range of external agencies to promote positive outcomes for residents. Staff have a good understanding of the needs of the people in residence and work with a positive and caring attitude. There is a strong ethos of respect in the service which impacts positively on residents quality of life. The service is well maintained and is set up to provide a warm and homely environment which is appreciated by residents. What the service could do better The continue to seek out opportunities to involve residents and their relatives/carers in the assessment and improvement of all aspects of service delivery, clearly demonstrating the outcomes of participation and how this helps to develop the service. The service should continue to develop the new personal planning format currently being introduced, making sure that the outcome is a person centred plan of care which is easy to follow and shows how care and support delivered is evaluated for effectiveness. Torwoodhall, page 3 of 22

The service should continue to build on current good practice and improve how it assesses and improves its own performance. What the service has done since the last inspection Since the last inspection the main area of change has been the development and introduction of a new personal planning system. Conclusion Torwoodhall is a comfortable care home. There was a relaxed atmosphere and staff were seen to be friendly and supportive. The manager is committed to further improving the service to help residents have a good quality of life. Residents taking part in this inspection were very happy with the quality of service and standards of care provided by the staff and manager. Who did this inspection Lesley Greig Andrea Daley Torwoodhall, page 4 of 22

1 About the service we inspected Torwoodhall is a residential care home which offers specialist care for 18 older people with a functional mental health needs and run by Falkirk Council. Before 1 April 2011 this service was registered with the Care Commission. On this date the new scrutiny body, Social Care and Social Work Improvement Scotland (SCSWIS), took over the work of the Care Commission, including the registration of care services. This means that from 1 April 2011 this service continued its registration under the new body, SCSWIS. The service operates from a traditional extended stone built villa which is set in extensive mature grounds. The home has many original features which afford it a homely ambiance. There had been recent development and upgrading of the home environment with an increase in the amount of en-suite accommodation. The communal areas of the home provide for independent tea and coffee making facilities and a mixture of lounge and dining areas, ensuring space for residents to choose to have company or have some private time. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 4 - Good Quality of Environment - N/A Quality of Staffing - N/A Quality of Management and Leadership - Grade 4 - Good This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website www.scswis.com or by calling us on 0845 600 9527 or visiting one of our offices. Torwoodhall, page 5 of 22

2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection We wrote this report following an unannounced inspection which took place on 5 and 6 March 2012. This inspection was carried out by inspectors Lesley Greig and Andrea Daley. As requested by us, the service sent us an annual return. The service also sent us a self assessment form. In this inspection we gathered evidence from various sources, including the relevant sections of policies, procedures, records and other documents including: -evidence from the service's most recent self assessment -a sample of residents personal plans -minutes of residents meetings -minutes of staff meetings -staff training records -notice boards -a sample of staff supervision records Discussions with various people including: -residents -the manager -staff We also spent time: -looking at the equipment and the environment (for example, is the service clean, is it set out well, is it easy to access by people who use wheelchairs); and -watching how staff worked with residents. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be Torwoodhall, page 6 of 22

doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection report continued Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at www.firelawscotland.org Torwoodhall, page 7 of 22

The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. We received a fully completed self assessment document from the service provider. The self assessment gave us information on the range of methods used to obtain the views of residents, carers and relatives on the quality of the service provided. We found the service required to consider and more clearly demonstrate how residents and relatives/carers views have improved the quality of the service provided, across all four Quality Themes. This will support the inspection process further. Taking the views of people using the care service into account We issued 18 questionnaires to the people who live in Torwoodhall. Seven people completed and returned questionnaires before the inspection. Two people strongly agreed and 4 people agreed that overall they were happy with the quality of the service provided to them. During the inspection we spoke with 9 residents. All of the residents gave us positive feedback, particularly on the quality of the staff and the food. Comments included: My carer (keyworker) is very good, all the staff are very good. No complaints, it's comfortable and my room's nice. My family visit often. We get together for a film night on a Saturday and make a bit of a party of it sometimes, I enjoy the company. I come and go as I please, if I want to spend time in my room it's up to me. We had a run to Callendar at the weekend and got fish and chips, it was lovely. The food's good and there's always a choice. She's a good cook. Taking carers' views into account We issued 18 questionnaires to relatives/carers of the people who live in Torwoodhall and 6 were completed and returned to us before the inspection. One person strongly agreed, and 5 people agreed that overall they were happy with the care their relative/ friend received in the care home. Four of the people who responded did not know that they could make a complaint to the Care Inspectorate, and 1 person disagreed there was enough social activity for residents. Torwoodhall, page 8 of 22

Comments included: The staff see my relative as an individual and are very good at keeping us informed. As far as I am concerned Torwoodhall staff provide and excellent standard of care. I am very happy with the care my relative receives in Torwoodhall. There were no carers present during the inspection. Torwoodhall, page 9 of 22

3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We sampled a range of evidence and found that the service had good performance in the areas covered by this Quality Statement. Residents and their relatives/carers had some good opportunities get involved in the assessment and improvement of the quality of care and support. All of the residents of the care home had a personal plan in place which gave an overview of their individual care and support needs. Most of the care plans we examined had been signed by residents to show they agreed with the content. Key workers had responsibility for making sure that residents were regularly consulted and involved in agreeing how they wished to be supported, including making sure people were involved in care planning. All of the residents we spoke with knew who their keyworker was and some residents told us of the value they placed on the keyworker relationship, with comments such as: '(Name) makes time for me, she knows when I need a bit more help and that I can find it hard to ask.' 'All of the staff are very good but its my carer (keyworker) I speak to if I'm worried about anything. Any issues and they would sort things out for me.' Many residents had regular access to and contact with Advocacy services. This meant that they had an impartial and independent person who could help to make sure their voice was heard. Advocates regularly supported people to take part in reviews of their care. We examined a sample of minutes of residents meetings which showed that discussions were taking place regularly, with residents being asked for their views and opinions. Most of these records had a focus on activities, entertainment and outings. We saw that suggestions had been actioned, for example a people had asked for day trips and these had been arranged. Torwoodhall, page 10 of 22

Areas for improvement As an area for improvement the service should build on the good practice in place and continue to expand opportunities for residents and their relatives/carers to have their say and influence service developments. For example, they could ask residents for feedback on the new care planning format. Care plans should be written in a way that is easy for people to understand. This could help the service to make sure care plans are clear, based on what people want and need and identify goals or outcomes which are person centred. The service should continue to build evidence of how they use feedback to develop or improve the service both for individuals and overall, for example by further developing summaries and action plans from questionnaires. The service has continued to work on introducing a new personal planning format. We found that there was inconsistency in where important information should be documented which made it difficult to track how some changes or needs were being taken forward. This is an area for the service to progress to ensure that residents needs are met. Evaluation of the effectiveness of care interventions were limited making it difficult to know whether agreed approaches to care and support were were having a positive outcome for residents. Consideration should be given to improving the way that information is shared with people following consultation. For example, we saw that there was a broad overview of the outcome of collated questionnaires on display but it was not clear if there had been any outcomes or changes as a result of the feedback gathered. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Torwoodhall, page 11 of 22

Statement 2 We enable service users to make individual choices and ensure that every service user can be supported to achieve their potential. Service strengths We sampled a range of evidence and found that the service had good performance in the areas covered by this Quality Statement. Please refer to Quality Theme 1 statement 1 for areas of strength which were also relevant to this statement. Residents spoken with confirmed that they were supported to make individual choices and had regular opportunities to take part in activities both within and out with the care home. Examples given included going out shopping, going out for a meal, meeting friends and family, some entertainment with in the home such as a regular cinema night and seasonal celebrations. Some residents told us they enjoyed spending time in the gardens. The home had access to transport and this was used to take people out for social outings and shopping trips. On one day of the inspection several people went out for a run in the bus, it was good to see that this could happen at short notice to suit the needs of people on the day. Residents rooms were personalised to suit their individual needs and taste. We were kindly invited into two residents rooms and saw that these were clean and well maintained. There was room for items of furniture, memorabilia and soft furnishings making them very comfortable and personalised. This helped to support peoples sense of ownership and belonging in the service. As detailed in Quality Theme 1 statement 1, some residents had regular contact with Advocates who could help to make sure that their rights were fully represented. Other residents had contact with befrienders giving them opportunities to build social links and positive relationships. Supportive social networks are recognised as being beneficial to the wellbeing of all people. Meetings were held where residents could discuss and agree on activities and outings. Residents spoken with told us they enjoyed these opportunities to get together and make plans. Areas for improvement Inspection report continued As an area for improvement the service should source some training in meaningful activities. This could enhance staff understanding, promote professional development and provide additional resources for the people in residence. Minutes of residents meetings should be improved to clearly show what has been discussed and how any ideas of suggestions will be taken forward. This would make it easier to track what has or has not happened as a result of feedback gathered from residents. It may also be useful for the service to gather feedback on some the Torwoodhall, page 12 of 22

activities taking place, this could allow the service to evaluate what people enjoy, what works well or how they might want change the activities available. The service should make sure that when residents have a certificate of incapacity that this is clearly signposted in personal plans. It would be good practice for the service to detail the areas where residents require additional support in decision making and demonstrate how this will be achieved. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Torwoodhall, page 13 of 22

Quality Theme 2: Quality of Environment - NOT ASSESSED Torwoodhall, page 14 of 22

Quality Theme 3: Quality of Staffing - NOT ASSESSED Torwoodhall, page 15 of 22

Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 4 - Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths We sampled a range of evidence and found that the service had good performance in the areas covered by this Quality Statement. Residents and their relatives/carers had some good opportunities get involved in the assessment and improvement of the quality of the management and leadership. Discussions with residents and observations during the inspection highlighted the accessibility of management. This meant that the manager was known to all of the residents who confirmed they were very approachable. Residents were confident that if they had any concerns they would be listened to and the manager would address any issues raised. Minutes of residents meetings showed a willingness on the part of the service management to keep people up to date on service developments and to seek out views and opinions. Areas for improvement As an area for improvement the service should build on the good practice in place and continue to expand opportunities for residents and their relatives/carers to have their say and influence service developments. The service should begin to look at how they evidence and ensure that changes they have made have the desired effect through quality assurance procedures. For example, after a period of time, they could ask people if they feel that communication about changes has improved as a result of the measures they put in place. They could also develop focussed questionnaires or surveys to get people more involved in the management and leadership of the service. This could enhance residents ownership of the care home and feed into improvement plans. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Torwoodhall, page 16 of 22

Statement 2 We involve our workforce in determining the direction and future objectives of the service. Service strengths We sampled a range of evidence and found that the service had good performance in this Quality Statement. Staff had some good opportunities to talk about and influence the direction and development of the service for the benefit of residents. For example: Staff contributed their views in a variety of ways, such as unit and whole team meetings and clinical reviews. This enabled them to share ideas and helped to promote continuity of care and support for residents. They were also able to talk about and review some policies, procedures and practice, for example in pain assessment. They reviewed the participation strategy each year. This helped them to share an up to date understanding of good practice and promoted consistent approaches across the staff team. Staff felt well supported by a system of 1 to 1 supervision that was in place. This meant they had planned time to meet with their line manager to talk about practice issues and look at continuing professional development needs. From this, there was some evidence that staff had identified and accessed training and development opportunities, for example; Moving and Handling updates and SVQ training. This contributed positively to people being supported by a trained and skilled workforce who were being prepared for future registration with Scottish Social Services Council. This also benefited the service by creating more potential opportunities for distributed leadership across the staff team. The main area for development over the last year has been introducing a new care plan format. Staff are fully involved in this process and have had opportunities to share views about what is working well and what could continue to be improved. Areas for improvement Inspection report continued The service should build on the good practice in place and continue to expand opportunities for staff to have their say and influence service developments. They could, for example, routinely include discussion on National Care Standards and the Quality Assessment Framework at team meetings. They could also develop staff surveys on these topics asking for feedback on what the service does well and any areas for improvement. This could be used to inform the overall self assessment and an annual development/improvement plan for the service, giving a clearer and shared sense of direction to all. Feedback from people using the service and other stakeholders should also inform these processes. Progress should be regularly audited as part of overall Quality Assurance procedures. The service should continue to build in opportunities for staff to share good practice Torwoodhall, page 17 of 22

and new learning, for example by including feedback from training as a standard agenda item at team meetings. Staff should be encouraged to evaluate training and look at how this is used to develop or improve practice to benefit residents. The service should monitor systems for 1 to 1 supervision and review to ensure that these are consistently implemented. Learning and development needs (that may not be a formal training course) could also be included in annual reviews and plans made to show how these will be met. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Torwoodhall, page 18 of 22

4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in SCSWIS re-grading the Quality Statement within the Management and Leadership Theme as unsatisfactory (1). This will result in the Quality Theme for Management and Leadership being re-graded as Unsatisfactory (1). Torwoodhall, page 19 of 22

5 Summary of grades Quality of Care and Support - 4 - Good Statement 1 Statement 2 4 - Good 4 - Good Quality of Environment - Not Assessed Quality of Staffing - Not Assessed Quality of Management and Leadership - 4 - Good Statement 1 Statement 2 4 - Good 4 - Good 6 Inspection and grading history Date Type Gradings 15 Dec 2010 Unannounced Care and support 4 - Good Environment Not Assessed Staffing Not Assessed Management and Leadership Not Assessed 7 Sep 2010 Announced Care and support 4 - Good Environment 5 - Very Good Staffing Not Assessed Management and Leadership Not Assessed 19 Feb 2010 Unannounced Care and support 5 - Very Good Environment Not Assessed Staffing 5 - Very Good Management and Leadership Not Assessed 19 Jun 2009 Announced Care and support 5 - Very Good Environment 5 - Very Good Staffing 5 - Very Good Management and Leadership 4 - Good Torwoodhall, page 20 of 22

12 Jan 2009 Unannounced Care and support Not Assessed Environment Not Assessed Staffing Not Assessed Management and Leadership 4 - Good 14 Jul 2008 Unannounced Care and support 4 - Good Environment 4 - Good Staffing 4 - Good Management and Leadership 4 - Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Torwoodhall, page 21 of 22

To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on 0845 600 9527. This inspection report is published by SCSWIS. You can get more copies of this report and others by downloading it from our website: www.scswis.com or by telephoning 0845 600 9527. Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: 0845 600 9527 Email: enquiries@scswis.com Web: www.scswis.com Torwoodhall, page 22 of 22