Inspection on 12/01/10 for Thornbury Care Centre

This is the latest available inspection report for this service, carried out on 12th January 2010.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Thornbury Care Centre 09/11/07

Thornbury Care Centre 26/02/07

Thornbury Care Centre 15/08/06

Thornbury Care Centre 30/11/05

Thornbury Care Centre 28/06/05

Thornbury Care Centre 23/03/05

Similar services:

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Blenheim House

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Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: Thornbury Care Centre 58 Thorndale Road Thorney Close Sunderland SR3 4JG     The quality rating for this care home is:   two star good 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: Sam Doku     Date: 1 4 0 1 2 0 1 0 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 28 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 28 Information about the care home Name of care home: Address: Thornbury Care Centre 58 Thorndale Road Thorney Close Sunderland SR3 4JG 01915201881 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.europeancare.co.uk European Care (England) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 44 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 Additional conditions: The maximum number of service users who can be accommodated is: 44 Date of last inspection Brief description of the care home Thornbury Care Centre is a three story building situated in the centre of Thorney Close. The home is registered for up to 44 people, 23 of whom have a dementia type illness. The home is built on a sloping site with accommodation for service users over two floors, with a service area on the lower ground floor. Accommodation consists of two Care Homes for Older People Page 4 of 28 Over 65 0 0 21 0 23 6 0 10 2 8 0 5 2 0 0 9 Brief description of the care home lounges, dining room and bathroom on each floor. A passenger lift serves the first floor, which specifically provides accommodation for people with dementia. All bedrooms are single occupancy and each benefits from en-suite shower and toilet facilities. The home provides accommodation for people who have a physical disability. There is a spacious garden to the rear of the home and a car parking facility is provided adjacent to the home. The home is situated close to local shops, pubs, places of worship and a community centre. The weekly fees payable are 422 to 533 Pounds for the EMI Unit, and 407 to 513 pounds for the residential and nursing unit. Care Homes for Older People Page 5 of 28 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: two star good 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: The quality rating of this service is 2 Star. This means the people who use the service experience good quality outcomes. The inspection was unannounced and commenced on 12 January and completed on 14 January 2010. Before the visit the inspector looked at: Information we have received since the last key inspection visit on 9 November 2007. How the home dealt with any complaints and concerns since the last inspection. Any changes to how the home is run. The views of the people who use the service through service user questionnaires. Care Homes for Older People Page 6 of 28 The views of the staff through staff questionnaires. During the visit the inspector did the following: Talked to the people who use the service, the previous manager and the new manager and also with the care staff and other staff who work in the home. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff have the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it is safe and secure. Checked what improvements have been made since the last inspection. The inspector told the manager what he found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use the services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 28 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 28 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 28 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. There are good assessment processes in place to make sure that the needs of the prospective residents are clearly identified before admission is arranged, thus promoting their welfare. Evidence: Five service user files were looked at to see how admissions to the home are arranged. These files show that the home receives assessments from the social worker or the nurse assessor before admission is arranged. The home also carries out their own assessment of needs to make sure that they have the necessary skills and resources to look after prospective residents before they are admitted to the home. Prospective residents are given the opportunity to visit the home and assess the place for themselves before they make up their mind to come and live at Thorndale Care Centre. Two residents who were spoken with confirmed that they came to look round the home with relatives before deciding on coming to live in the home. Staff also Care Homes for Older People Page 11 of 28 Evidence: confirmed that this is practice that takes place regularly. One staff member confirmed that in the case of people with dementia, it is not always possible for the prospective resident to visit, but very often relatives do this on behalf of the resident. The service user guide and statement of purpose provide useful information to residents and relatives about the service and the facilities in the home. Care Homes for Older People Page 12 of 28 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 residents receive good personal and healthcare support. However, staff need to be observant to sageguard the dignity of the residents. Evidence: The residents files contain details of comprehensive assessments including risk assessments and risk management plans that the care staff work to. The assessments include nutrition, mobility, maintaining safe environment, manual handling and communicating. From these assessments, the care plans are put together to direct staff on how best to meet the individuals needs. The care plans are regularly reviewed and updated to reflect the current care needs of the residents. However, some of the care plans are too generalised and do not address specific needs of the individuals. For example, statements like, to be assisted with all personal care needs is not specific enough in letting staff know what the resident can do independently and what they would need assistance with. The residents files show that people receive regular medical support, including GP visits, visits by Consultant Psychiatrist, hospital outpatient appointments, tissue Care Homes for Older People Page 13 of 28 Evidence: viability nurse input, chiropody, opticians and other healthcare inputs. Accurate records are maintained of all these visits on individual files. The nursing notes also provide details of the care and support that individuals receive from the care and nursing staff. The nursing notes are dated and signed on daily basis. The inspector discussed with the manager the issue relating to named nurses for the residents. There only two full-time nurses in the home at the moment, not including the manager who is RGN and RMN. Further discussions with the nurse on duty indicates that she is the named nurse for all the residents as she is the only full time nurse on the day shift. Consequently, there is no key worker system in place. The newly appointed manager recognises the problems in this case and assured the inspector that the situation is currently being reviewed and a lot of effort is going into trying to recruit more trained nurses despite the difficulties in recruitment and retention of nurses. There is good medication policy in place and examination of the medication administration system showed that the trained staff adhere to the correct procedures. The inspector carried out a random inspection of the medicines that are held in the home. There were no discrepancies noted, and all the recording sheets have been appropriately signed and dated. The inspector spent sometime in the various lounges to observe staff practices and how staff interact with the residents. Staff were very courteous and respectful of the residents. People who required assistance with personal care were offered this in a discreet manner and in ways that safeguarded the dignity of the residents involved. However, staff need to be more observant, as in one case a resident clearly needed attention with his personal care and hygiene but staff failed to observe this and the inspector had to bring it to the attention of one carer. Care Homes for Older People Page 14 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents have opportunities for social and recreational activities which enhance their quality of life, thus enhancing the residents life experience. Evidence: The activities coordinator is very enthusiastic about his role and the staff stated that his role has been very beneficial to the residents, and in particular the residents on the EMI unit. Service users and relatives commented on the positive attitude of the activities coordinator and how he is always finding different ways to engage the residents in recreational activities. Staff confirmed that there are visits from the local church on a monthly basis. Staff said that no resident has expressed the wish to attend church services on Sundays. The inspector looked at the residents files and those that were inspected showed that peoples religion has been stated and in one case the record show that their religious needs were discussed as part of their care plan. The residents said that they get up and go to bed when they want. One resident said I have always had a lie-in in the morning and this has not changed since coming here. One residents also said she gets a cups of tea from the staff when she first gets Care Homes for Older People Page 15 of 28 Evidence: up in the morning. Others residents also confirmed that they get cup of tea first thing in the morning when they get up. The inspector had lunch with the residents on the first floor. The experience was one of calm and organised activity. Residents who required assistance with their meal were offered this in a discreet and dignified manner. Residents were given plenty of time to eat their meals and there was no feeling of people being hurried. The residents commented positively on the choice and quality of of meals that is provided. Examination of the menus shows that there is a four week rotating menu and the cook indicated that the menus are regularly reviewed and changed if necessary. The residents questionnaires that were received also showed that generally the residents are happy with the quality of the meals provided. Care Homes for Older People Page 16 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems in place to protect the residents from all forms of abuse. However, staff need up to date training in Mental Capacity Act and Deprivation if Liberty Safeguards to safeguard the residents rights. Evidence: The home has a complaints procedure and a copy of this is posted in the reception area for residents and visitors to see. A summary of the complaints procedure is also included in the service user guide. Three of the four residents who completed the CQC service user questionnaire said that they know how to make formal complaint. The complaints record has details of all the complaints received by the manager. This records show details of investigations and outcomes. Copies of letters to complainants are kept on file. The inspector spoke with residents and relatives about the complaints procedure. Residents and relatives said they are aware of the procedure and feel confident about raising any concerns with the manager if they were unhappy about anything. Staff members were also spoken with about the homes complaints procedure. Staff showed good knowledge and understanding of the complaints policy and procedure, and knew how to support residents if they wish to make a complaint. The staff who were interviewed had limited knowledge of the mental capacity act and also the deprivation of liberty safeguards, and stated that it would be helpful for them to have a formal Care Homes for Older People Page 17 of 28 Evidence: training. The inspector raised this with the newly appointed manager who later on submitted action plan to the Commission indicating that the training has been arranged to be provided to all staff between March and June 2010. The new manager confirmed that all staff have had training in safeguarding adults previously but arrangements are being made to provide a refresher training to all the staff. The home has a good system in place for accounting for the residents personal allowance. Receipts are available for purchases made on the residents behalf. A random check of the accounts showed no discrepancy in the amount of monies held for the individuals. Care Homes for Older People Page 18 of 28 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. The home is safe, secure, clean, warm and provides a pleasant environment for the residents to live in. Evidence: The home is clean and maintained to a good standard. Individual bedrooms that were visited were clean, appropriately furnished and maintained to a good standard. The bedrooms are spacious, comfortable and well maintained. People have been encouraged to bring into the home their personal items such as pictures, photographs and small items of furniture to furnish their rooms with. As a results, some bedrooms look homely and reflect individual tastes and preferences. All radiators have protective coverings and windows have restrictors on to stop intruders and to ensure the safety of the residents. Bedroom doors have devices on to hold the bedroom doors open for those residents who wish to have their bedroom doors open. The communal areas were clean and pleasantly furnished. Relatives commented that the home is always clean and has never had bad odour. Comments from the service user surveys were complimentary about the cleanliness of the home. The kitchen was well ordered and clean. The kitchen staff have maintained good hygiene standards. The catering staff pointed out to the inspector that the sluicing tap in the kitchen had Care Homes for Older People Page 19 of 28 Evidence: not worked for sometime now. This was brought to the attention of the manager and arrangements were made almost immediately to have the defective item replace and back to good working condition. The maintenance man has a record of all the work that he does in the home to keep it in a good state of repair. Regular water temperatures are taken and the records show that the water temperatures in the bathrooms and bedrooms are maintained at safe levels. The laundry area is clean and well maintained. The washing machines are suitable for washing soiled linen when washing at high temperature is needed. It was noticed that the location of the laundry has its problems. There is little or no natural lighting to the laundry room, and the laundry assistant works in an area that is cold and drafty. There are written policies covering all aspects of the running of the home, including health and safety. Care Homes for Older People Page 20 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is lack of up to date training in some essential areas of practice which potentially compromise the safety and welfare of the residents. Evidence: The home employs sufficient number of staff to meet the needs of the residents. There is a registered nurse on duty at all times including night duties. Staff were spoken with about the staffing levels in the home. They all said that the staffing levels are always adequate. Some expressed concerns about the limited number of full-time trained nurses in the home. The inspector spoke with the new manager who is aware of the problem with recruitment and retention of trained nurses. She indicated that at the moment there are only two full time nurses, one on day shift and the other on night shift. She said that the company is making suitable arrangements to employ more full time nurses in order to ease the pressure on the two full time nurses, particularly the nurse on day shift. Meanwhile, any extra nursing support is provided by nurses from other homes within the company. Examination of staff training records show that most staff do not have up to date training. Of the 26 care staff, 9 have current fire safety certificate, none has been receiving the twice a year fire awareness instructions, none has up to date refresher training in moving and handling, 3 had dementia awareness training and 7 have valid first aid training. Care Homes for Older People Page 21 of 28 Evidence: The line manager for the home explained that all these training were arranged to take place but the recent bout of Swine Flu related illnesses amongst the staff team prevented staff from attending these training courses. In order to address this issue as a matter of urgency, the manager has provided the Commission with an action plan to commence staff training, starting this February 2010. Four staff files were examined to check on the recruitment process by the manager. The files show that the home has been following good recruitment procedures. All the files contain completed job applications, copy of job description, appropriate references, evidence of CRB checks and record of induction and training. Care Homes for Older People Page 22 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. On the whole, the home is well run and meets the needs of the residents. Evidence: A new manager has recently been appointed and at the time of the inspection visit, she had just completed her induction period with the previous manager. The new manager is s registered nurse in both general and psychiatric nursing. She has had previous experience of managing care homes. The manager indicated that she has submitted her application to the Commission to be registered as the registered manager for Thorndale Care Centre. Staff records show that staff supervision takes place on regular basis. Record of supervision are kept and the current managing is in the process of arranging the next schedule of staff supervision for this year. The providers Health and Safety policies remain in place. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH). There Care Homes for Older People Page 23 of 28 Evidence: is evidence that staff generally adhere to the policies as set by the provider. Servicing and maintenance records show that all portable appliances have been tested. A record is maintained of regular water temperature in bedrooms, toilets and bathrooms. Regular servicing of fire equipment, passenger lift, bath lifts and hoists, gas and electrical appliances have been carried out by the contracted companies. All the servicing records that were examined were up to date. The homes fire risk assessment is up to date although there are two versions which can be confusing. Records examined indicate that fire precautions relating to weekly fire alarm testing and record of inspection takes place. The home has good system in place handling the personal allowance for the people that they hold monies for. Receipts are available for all purchases that have been made. The records are regularly audited and are signed by two people. Care Homes for Older People Page 24 of 28 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 28 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 1 17 13 Safeguarding adult training, including deprivation of liberty safeguards must be provided to all staff to safeguard the rights of the residents. Staff training record shows that only three staff have had POVA training, and no record to show that staff have had training in mental capacity act and deprivation of liberty safeguards. 30/06/2010 2 28 13 The provider must make 31/03/2010 necessary arrangements to provide all care staff with up to date or refresher training in moving and handling. Training record shows that only 8 of the care staff have had up to date training in moving and handling. Care Homes for Older People Page 26 of 28 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 2 10 27 Staff should attention to residents personal hygiene to protect the residents self esteem and dignity. The provider should continue to make efforts in their recruitment of nurses in order to ease the pressure on the two full time nurses. All staff should receive up to date fire safety training and fire safety awareness instructions. All the care staff who work on the dementia care unit should receive dementia awareness training. 3 4 28 30 Care Homes for Older People Page 27 of 28 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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