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Inspection on 06/05/09 for Thornbury Residential Home

Also see our care home review for Thornbury Residential Home for more information

This is the latest available inspection report for this service, carried out on 6th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Resident appeared happy and settled in the home and generally enjoyed being there. Activities are varied and range from belly dancing through to quizzes and art work. `We all help each other and sort out each others problems`.` staff are lovely`,`food is lovely`

What has improved since the last inspection?

The Registered Manager has ensured that the requirements and recommendations highlighted during the last inspection have been met; there are now comprehensive procedures in place surrounding the administering of medication. Evidence was supporting to confirm that the Registered Manager deals with complaints effectively, and the CCTV cameras have been removed from communal areas. Laundry procedures have improved. Service users are not left unattended during staff breaks and staff receive supervisions in line with the national minimum standards. Accidents and incidents were recorded correctly and evidence was supporting to show appropriate action is taken and relevant agencies are contacted. Risk assessments have been improved and are now more detailed, as are health action sheets. Activities have improved, and staff are trained in POVA. Evidence was supporting to confirm that the staff have a good understanding of individual`s behaviours and guidance is in place. Fire drills are up to date and service users are provided with keys to their rooms unless a capacity or risk assessment suggests otherwise. The home has quality assurance systems in place.

What the care home could do better:

The Registered Manager must ensure that the correct procedure is followed for gaining staff references in the home. During the inspection a window which required a covering in the upstairs bathroom was identified, the Registered Manager assured the inspector that this would be covered by the end of the next working day. The Registered Manager should also ensure the sheets which they have been created to obtain consent to administering service user`s medication have been signed by the individual.

Key inspection report Care homes for older people Name: Address: Thornbury Residential Home Hempstead Road Uckfield East Sussex TN22 1DT     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: Alexis Reilly     Date: 0 6 0 5 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 25 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 25 Information about the care home Name of care home: Address: Thornbury Residential Home Hempstead Road Uckfield East Sussex TN22 1DT 01825765502 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: admin@thornburyresidential.uwtadsi.co.uk thornburycare.co.uk Mr John Johnson,Mrs Alyson Johnson care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: A maximum of nineteen elderly people to be accommodated (19) Service users must be aged 65 years and over on admission Date of last inspection Brief description of the care home Thornbury is a residential care home providing personal care and accommodation for nineteen older people, being situated in walking distance from the town centre of Uckfield. The registered proprietor has owned and managed the home for over twenty one years. The property is a two storey detached house with a stair lift for access between the floors. All service users benefit from single bedrooms, five of which have ensuite toilet facilities. There is a pleasant garden at the front of the building that is well maintained with garden furniture available during fine weather. The home also has a patio at the rear of the building. Both the garden and patio areas allow easy access for service users. The home is attractively decorated and communal areas comprise of a conservatory leading off from the large main lounge with a separate dining room. The home has three communal bathrooms with assisted bathing facilities and three Care Homes for Older People Page 4 of 25 0 Over 65 19 Brief description of the care home toilets. At the time of Inspection the accommodation fees at the home range from £400 to £450, with additional costs required for personal toiletries, newspapers and hairdressing. Care Homes for Older People Page 5 of 25 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 inspection began at 10am and finished at 2pm. The inspector spent time with two of the three service users involved in case tracking and met with other residents in a group during the morning of the inspection. The inspector case tracked three service users, examining the care plans and the associated documents such as risk assessments and activity plans for these individuals. Other documents examined were copies of notifications, accidents and appointments, evidence of external reviews, the complaints procedure, menus, and the collated report for quality assurance surveys, copies of service users meetings, and staff meetings. Staff recruitment files, records of supervision and training certificates were also examined, as were a sample of the sheets which record the administration of medication and the duty rota. A partial environmental tour was carried out which included all communal areas, Care Homes for Older People Page 6 of 25 lounge, dining area, conservatory, kitchen and the three bedrooms of the service users case tracked. The inspector spent time with the Registered Manager, senior carer, and spoke with the cook. The inspector also observed other staff interacting in a positive manner with service users during the inspection. In the report the inspector has included comments from people met on the day of the inspection. Information was also taken from the AQAA which was comprehensively filled in and returned by the due date, and also from the improvement plan which was submitted following the last inspection. This was comprehensively filled in and evidence found on the day of the inspection supported the improvements made in the home. During the course of the inspection the inspector received comments from staff and residents in the service the content of which are included in the report. Care Homes for Older People Page 7 of 25 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 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 8 of 25 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 9 of 25 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. Evidence was supporting to confirm that service users benefit from receiving relevant and up to date information, which enables them to make an informed choice about the home prior to moving in. The service carries out Pre Admission Assessments and obtains the relevant information so as to ensure that an appropriate level of care can be offered and that service users needs can be met. Evidence: As part of the inspection the inspector case tracked three service users in the home and spent time with two of the three residents. The inspector also spent time with the majority of residents during the morning of the inspection and enjoyed their company in their conservatory. Staff were observed interacting in a positive manner with service users throughout the inspection. The inspector also had the opportunity to speak with the senior carer and the Registered Manager. As part of the case tracking the inspector examined the person centred care plans and the associated documents such as risk assessments and the activity schedule, also evidenced were the external Care Homes for Older People Page 10 of 25 Evidence: reviews from the placing team to ascertain if the needs identified in the assessment are used as a basis for a comprehensive care plan. The inspector examined the care plans and associated documents of two service users who had been admitted since the last inspection, evidence was supporting to confirm that service users are involved in the admissions process and are given choice, the service had comprehensive assessment document in place which was used to assess someone referred to the service. Also available to view was collated information with regard to service users in the home, and their referring documents. This highlighted that the Registered Manager obtains background information and up to date CPA and mental health assessments if applicable prior to offering a place in the service. Intermediate care is not offered by this home. Care Homes for Older People Page 11 of 25 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. Care plans and procedures are in place and are sufficient to ensure that a good provision of health care and personal support is provided to service users by the home. Evidenced was supporting to confirm that care is administered in a way that protects service users privacy, and dignity, and that peoples independence is promoted. Medication procedures are in order. Evidence: As part of the inspection the inspector case tracked three service users in the home and spent time with two of the three residents. The inspector also spent time with the majority of residents during the morning of the inspection and enjoyed their company in their conservatory. Staff were observed interacting in a positive manner with service users throughout the inspection. The inspector also had the opportunity to speak with the senior carer and the Registered Manager. As part of the case tracking the inspector examined the person centred care plans and the associated documents such as risk assessments and the activity schedule, also evidenced were the external reviews from the placing team to ascertain if the needs identified in the assessment are used as a basis for a comprehensive care plan. The records of accidents were also Care Homes for Older People Page 12 of 25 Evidence: viewed. Care plans examined were clear and easy documents to follow. Evidence was supporting to confirm that service users are respected and personal care is delivered maintaining individuals privacy and dignity. Medication procedures have improved and there are comprehensive documents in place to support peoples choices with regard to self medicating or not in the home. Staff are trained in the Administering of Medication, and staff records confirmed this. Evidence was supporting to confirm that service users health care needs are addressed and that the service has a clear record of falls and accidents in the home and that these are acted upon. The inspector evidenced through out the care plans good practice examples in the way service users were to be encouraged and their independence promoted and maintained. The service has policies in place in respect of anti discrimination, equal oportunities, racial harasment and bullying. The Registered Manager has ensured the working environment is supportive and non threatening by not tolerating acts of discrimination or harassment and by introducing standards of behaviour contained within a code of conduct for all our employees. Emphasis on this policy is in the services Induction programme ensuring every member of staff has read and signed the policy. Care Homes for Older People Page 13 of 25 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. Evidence was supporting to confirm that a range of social and recreational activities are on offer with the wishes of the service users being central to the provision. The menu is varied and specialist diets are provided for service users, with service users choice and wishes being respected. Evidence: As part of the inspection the inspector case tracked three service users in the home and spent time with two of the three residents. The inspector also spent time with the majority of residents during the morning of the inspection and enjoyed their company in their conservatory. Staff were observed interacting in a positive manner with service users throughout the inspection. The inspector also had the opportunity to speak with the senior carer and the Registered Manager. As part of the case tracking the inspector examined the person centred care plans and the associated documents such as risk assessments and the activity schedule, also evidenced were the external reviews from the placing team to ascertain if the needs identified in the assessment are used as a basis for a comprehensive care plan. The service runs a range of activities from belly dancing, arts and crafts to quizzes. During the morning of the inspection the service users were engaged in a quiz in the conservatory and enjoyed a sherry prior to going into the dining room for lunch. Care Homes for Older People Page 14 of 25 Evidence: Service users spoke about the picture frames they had made during the craft session, and appeared to be engaged and enjoying the quiz in the morning. Evidence was supporting to confirm that service users are involved in resident meetings. Individual service users confirmed what was discussed at the last residents meeting and feel that their opinions are valued. Service users confirmed they enjoyed the food and evidence was supporting to confirm that there is always sufficient fresh fruit, vegetables and meat to use for meals in the home. Service users independence in daily living is promoted and people are encouraged to carry out their own self care. Service users who access the community independently now have a risk assessment in place. Care Homes for Older People Page 15 of 25 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. Service users benefit from a robust and efficient complaints procedure, whilst the homes procedures and processes protect service users. Staff are trained in the Protection of Vulnerable Adults. Evidence was supporting to confirm that service users felt there views were taken into consideration. Evidence: During the inspection the inspector examined copies of notifications, and accidents and appointments, evidence of external reviews, and the complaints procedure. Evidence was supporting to confirm that complaints are dealt with effectively by the home. In addition evidence was supporting to confirm that residents felt able to raise concerns with the Registered Manger or staff and that these would be dealt with. The CQC had previously contacted the Registered Manager in relation to a concern with regard to medication administration in the home this was addressed by the Registered Manager effectively and quickly. The service has policies and procedures regarding service users monies, and financial affairs. Evidence was supporting to confirm that any accidents or incidents in the home are recorded and appropriate action is taken. Care Homes for Older People Page 16 of 25 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. Evidence was supporting to confirm that accommodation at the home is provided in such a manner that it is safe, hygienic and odour free. Appropriate infection control procedures are in place, in order to reduce or eliminate the risk of infection to staff and service users. Evidence: As part of the inspection the inspector carried out a partial environmental tour of the home, which included all communal areas, dining room, lounge, conservatory, kitchen, office and bathrooms. The service users bedrooms who were involved in case tracking were also inspected. The home is well maintained and all areas of the home, including the garden, are accessible to service users. The home was clean and odour free throughout. The home has an infection control policy in place and staff are trained in infection control procedures, staff training records viewed confirmed this. The service has two laundry rooms so soiled washing is not carried through the home. The upstairs laundry room was upgraded following the last key inspection in May 2008. The front garden is accessible to all residents and maintained with the aid of an outside contractor. Records are kept regarding all maintenance. The service now has a full-time maintenance person who responds immediately to any problems and urgent Care Homes for Older People Page 17 of 25 Evidence: repairs. Thornbury is fitted with handrails and grab bars, and raised toilet seats. Two of the sinks in the bedrooms are wheelchair accessible if required. The call bell system is checked professionally every quarter with the fire alarm system. The front path leading into the home has been ramped and the rear courtyard has been repaved and ramped for wheelchair access. Care Homes for Older People Page 18 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are on duty to meet the needs of the service users placed. Staff receive appropriate training and supervision. Staff recruitment procedures are effective however the home must ensure they follow the correct procedure for gaining references for prospective employees, to ensure service users are protected from potential harm or risk associated with poor recruitment practices. Evidence: As part of the inspection the inspector examined the recruitment files of two newly recruited staff to the service. These documents were comprehensive and contained relevant information, however one of the files had only one written reference. The Registered Manager must ensure they obtain two written references relating to the person. A list of staff training was seen as were copies of staff meetings, training certificates and the record of staff supervision, and the record of staff enrolled on NVQ qualifications in the home. Evidence was supporting to confirm that over 50 of staff have completed NVQ qualifications, and are progressing toward NVQ level 3, and that staff received appropriate training and supervision to enable them to carry out their role. Comments received on the day of the inspection confirmed that staff are employed in sufficient Care Homes for Older People Page 19 of 25 Evidence: numbers to address the needs of the service users placed in the home. Care Homes for Older People Page 20 of 25 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. The Registered Manger has ensured that service users live in a safe and well manager service which is run in their best interests. Evidence: As part of the inspection the inspector case tracked three service users in the home and spent time with two of the three residents. The inspector also spent time with the majority of residents during the morning of the inspection and enjoyed their company in their conservatory. Staff were observed interacting in a positive manner with service users throughout the inspection. The inspector also had the opportunity to speak with the senior carer and the Registered Manager. As part of the case tracking the inspector examined the person centred care plans and the associated documents such as risk assessments and the activity schedule, also evidenced were the external reviews from the placing team to ascertain if the needs identified in the assessment are used as a basis for a comprehensive care plan. The Registered Manager has worked hard to address the shortfalls of the last Care Homes for Older People Page 21 of 25 Evidence: inspection and the requirements and recommendations have been met. Evidence through out the inspection was supporting to confirm that service users received a good level of service. Care plans and risk assessments were informative, activities are provided and service users dignity and independence is respected. Service users health care needs are addressed and referrals made where appropriate. Staff are well managed, supervised and trained. However service users are not fully protected by the homes policy on recruitment, and the Registered Manager must ensure that the correct procedure is followed with regard to obtaining references for employees in the home. Evidence in the AQAA confirmed that policies and procedures are in place with regard to health and safety within the home. Care Homes for Older People Page 22 of 25 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 23 of 25 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 29 19 The Registered Manager must ensure they obtain in respect of that person the information and documents specified in (i) paragraphs 1 to 7 of Scedule 2. To ensure service users are fully protected by the homes recruitment procedures. 01/07/2009 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 Care Homes for Older People Page 24 of 25 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. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!