CARE HOMES FOR OLDER PEOPLE
Thornton House 94 Chester Road Childer Thornton South Wirral Cheshire CH66 1QL Lead Inspector
Mr Val Flannery Key Unannounced Inspection 31 October 2008 08:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Thornton House Address 94 Chester Road Childer Thornton South Wirral Cheshire CH66 1QL 0151 339 0737 F/P 0151 339 0737 thorntonhouse@btconnect.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Andrew Henry Blomfield Beryl Tidbury Care Home Only (PC) 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th October 2006 Brief Description of the Service: Thornton House is registered as a care home for older people who may need help with personal care tasks. The home is privately run with the owner taking an active part in the day to day management. The home is located on the outskirts of Ellesmere Port in a small community, within reach of local services, community facilities and public transport. The facilities include single bedroom accommodation, a separate dining room and three lounge areas, one of which is a conservatory extension to the building. A stair lift is available to transfer residents between the ground and first floors. There is a large and wellmaintained garden to the rear of the property. Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes.
We carried out this unannounced visit to Thornton House on 31 October 2008. The visit lasted 8 hours in total and was done by one inspector. The report will say ‘we’ when referring to our activities and findings, as it is written on behalf of the Commission for Social Care Inspection. The visit was just one part of the inspection. Before then the manager was asked to complete a questionnaire to provide up to date information about service offered by Thornton House. CSCI questionnaires were made available for people living in the home and staff to find out their views about the home. Other information received by CSCI since our last inspection of the home in October 2006 was also reviewed. During our visit we looked at various records and spoke with people living in the home to find out their views about it. We looked at care files to check the care that people who live at the home are receiving. We spoke with staff to find out how much they knew about the needs of the people living at Thornton House and their views about how the home is run. We also spoke with the manager and the owner. Comments we received are included throughout the report. What the service does well:
The information we received from people who live at Thornton House showed they were happy with the home and felt their needs were being met there. People who may wish to live in the home are visited by senior staff who carry out an assessment of need. This helps to make sure the person’s needs can be met there. People who live in the home are consulted on how they wish to live their daily lives. They are consulted about the service offered by the home and if they are satisfied that their needs are being met. This is to make sure they are satisfied with the care they receive and that it meets their needs. People who live at the home are helped to keep in touch with relatives and friends who are able to visit the home as they wish to keep up a good level of contact with their relative.
Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 6 The health care needs of the people living at Thornton House are identified and plans put in place to make sure doctors, nurses and other healthcare professionals visit them as required. This makes sure that their healthcare needs are met. People living in the home receive help with personal care from staff in a way to make sure their privacy and dignity is respected. The home has a complaints procedure in place that is made available to the people who live there, relatives and staff. This helps to make sure that people who live at the home can be confident that their concerns will be listened to and acted upon. There is a thorough safeguarding adults procedure for the home and staff receive training on this to make sure that people living at Thornton House are safe and protected from possible harm. The home is well maintained so the people who live there are cared for in a secure, clean and well-maintained environment. The staff working in the home are aware of the needs of the people who live there so they know how these needs should be met. The home is managed well so it is run in the best interests of the people who live there. What has improved since the last inspection? What they could do better:
The manager should complete the Registered Managers award as soon as possible. Staff training should include input from external trainers, particularly for safeguarding adults protocols, to help staff keep up to date with best practice.
Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 7 The format for recording plans of care and other important information should be improved so it is more accessible to the people who live in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. People’s needs are assessed before they move into the home so they and the staff at the home know people’s needs can be met there. EVIDENCE: We looked at the care files of two people who have recently moved into Thornton House. These contained copies of information about the person and their needs that had been gathered by staff from the home before the person moved in. The files also had copies of the assessment of need documentation done by the social services care manager. The manager told us that all the people living in the home currently were referred through social services. She also said either she and/or the owner of the home visit people before they are come to live at Thornton House to make sure the person’s needs can be met there. They speak with the person and their relatives, then with the information provided draw up an initial plan of care.
Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 10 We spoke with the two people whose files we looked at and they told us their relatives had visited the home on their behalf. They both told us they thought their relatives had made a good choice for them. Both said they were made to feel very welcome by staff and had settled very well. We also spoke with relatives of both people during our visit. They confirmed that they had visited the home before their relative had moved in. Both were very positive about the home and said their relatives ‘could not be in a better place’. Thornton House does not provide intermediate care so standard 6 does not apply. Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service The care plans are kept up to date and identify people’s personal and health care needs with information about how these should be met so staff can provide people with the care they need in the way they prefer. EVIDENCE: During our visit, we spoke with three people who live at the home and four relatives who were visiting. Two people who live in the home told us ‘staff are very good at getting the doctor or nurse if we are not well’. The care plans we saw showed that the people’s health care needs are identified and recorded. They included information about what staff needed to do to make sure people’s needs were met. We saw letters in two files confirming hospital appointments with healthcare specialists, showing that referrals were being made and appointments being kept to make sure that people’s healthcare needs were being met. The manager told us in the information that was sent to us before we visited
Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 12 the home: ‘We ask for referral to other professionals such as psychiatrists, psychologists, dieticians, speech therapists, physiotherapists and the rapid assessment unit where we think these may be appropriate.’. The four relatives we spoke with said they have no concerns about the health care needs of the their relatives who live in the home. They also told us that staff from the home keep them informed about their relatives. During our visit, we saw the owner of the home giving out medicines to people who live there. We also checked the medication administration records which were kept accurately to show that people were receiving their medicines as prescribed by their doctors. The medicines for people who live at Thornton House are kept securely and there are policies and procedures about giving medications to make sure this is done safely. The manager told us that none of the people living at the home at the time of our visit administers their own medicines. The people we spoke with during our visit said that staff treated them with respect and maintained their dignity when attending to personal care needs. The telephone that people who live in the home can use is in a quiet area so they can make phone calls in private and people receive their mail unopened. Two people we spoke with also had a telephone in their own room. We heard staff address people in the way each person preferred. People’s care plans and other information about them are kept folders. On the day of our visit, the folders we looked at were untidy and the information in them was not always easy to find or follow. We spoke with the manager about different methods of maintaining care plans and other information to make it were easier for staff to find the relevant information to make sure people living in the home were receiving the care they needed in the way they preferred. Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service People who live at Thornton House have choices about their daily activities so they can remain as independent as possible and retain control over their lives. EVIDENCE: The people living in the home said they are encouraged and supported by the staff to be as independent as possible. During our visit, we saw people moving about the home between their bedrooms and the communal areas. We saw staff offering help where necessary, for example, when people asked for help to use the stair lift to get from the first to the ground floor of the home. Staff were also seen helping people with their mid day meal; this help was given in a quiet and sensitive manner. The four relatives we spoke with during our visit told us they had visited the home before their relative moved in. They told us they had been impressed with the welcome they had received and the atmosphere in the home. They said they can visit the home as they wish and are kept informed of any incidents/accidents involving their relative. One of the relatives said staff
Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 14 often have to deal with difficult situations but they do this in a calm and caring manner. The activity organised by the activity co-ordinator during the afternoon of our visit was well attended by the people living in the home. One person we spoke with said they do not join in the activities and prefer to stay in their bedroom doing puzzles, reading or watching TV. Another told us he joins in the organised activity when he is in the mood. This shows that people have a choice about what they do each day. During our visit, we saw people who live in the home reading the daily paper, chatting amongst themselves or having their hair done by the visiting hairdresser. The mealtime seen during the inspection was calm and relaxed. The meal consisted of a light lunch with the main meal being served in the evening. Staff were seen helping people with their meals in a sensitive and caring manner. People who live in the home told us they think the food is good and they are offered choices for most meals so they can have the meals they prefer. Staff were seen offering people hot and cold drinks throughout day of our visit. One of the people who live in the home that we spoke with told us this is happens every day. Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Policies and procedures are in place so that the people living in the home are protected from abuse and harm. EVIDENCE: The people we spoke with during our visit, including people who live in the home, relatives and staff, all told us they knew how to raise complaints or concerns with the manager or owner of the home. They also said they were satisfied that any complaints and concerns would be taken seriously and acted upon. We looked at the complaints records and these showed that the manager or homeowner satisfactorily dealt with any concerns raised. A copy of the complaints procedure was on display in the home and included details on how to contact us if needed. The manager told us that no referrals from the home had been made under the local safeguarding adults procedures. The staff files we looked at showed that staff had received information about safeguarding during their induction training by watching a video on protecting people from harm and abuse. A member of staff we spoke with said they have received updated training on adult protecting people from abuse. This is usually arranged and presented by the manager. Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 16 The people spoken with during the inspection who live in the home said they ‘were well looked after’ and had no concerns about the way staff treated them. Discussion took place with the manager on the implementation of the local safeguarding adults procedures and how all services providing care for vulnerable people should be aware of any changes and updates on these procedures. Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 and 26 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service The home is well-maintained so people living there do so in safe and comfortable surroundings. EVIDENCE: The home is in Childer Thornton, which is close to Ellesmere Port. The home is close to a dual carriageway, however the measures taken to minimise any noise have been very effective and the people spoken with said they are not aware of the traffic. The lay out of the home allows the people who live there to be able to move about in safety and comfort. People who live in the home had access to all parts of communal and private space through the provision of ramps and a stair lift. Aids, hoists and assisted toilets and baths were installed. A call system was provided in every room. All of the bedrooms are single and contain hand-washing facilities. A number of rooms have en-suite toilet and bathing facilities. The rooms we saw on the day of our visit were
Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 18 individually furnished and contained items of personal possessions belonging to the people living in those rooms. This helped to make them more homely. Three of the people we spoke with during our visit said their bedroom suited their needs and that staff keep the bedrooms clean and tidy. Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. There are enough staff on duty at Thornton House so that the assessed needs, safety and well being of the people living in the home can be met. EVIDENCE: On the day of our visit, there were three care staff on duty plus the manager and the owner. The manager told us there are normally at least three care staff on duty during the day and two care staff during the evening and night. In addition to the care staff, there were domestic and kitchen staff on duty. The manager said they are in the process of recruiting additional staff. The manager told us in the information we received from her before our visit, ‘We do not use agency staff. Bank staff are those who have left to carry out nurse training. 64 of staff are either NVQ trained or are working towards. The core night staff have been with us many years…’. We looked at personnel files of two staff members to check on how they were recruited to work at the home. The information we saw in the files included a completed application form, two references, Criminal Record Bureau checks, an induction training checklist and record of training including safeguarding adults. The training records showed that training is mainly provided by the use of video and questionnaires. The staff members we spoke with during out visit said the manager carries out most of the training provided to staff. They
Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 20 also said they receive support and supervision from the management team and are able to approach them for advice and guidance. During the inspection discussion took place with the manager on how the training provided to staff could be improved by the use of, for example, external trainers or organisations, particularly in regards to safeguarding adults. The people who live in the home and the relatives that we spoke to were all positive about the staff and the way they care for people. They said they were made to feel welcome by staff when they first visited the home. During our visit, we saw staff caring for the people who live in the home in a calm, sensitive and caring manner particularly when assisting with personal care such as using the bathroom and moving about the home Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. The home is well managed so that it is run in the best interests of the people who live there and equipment in the home is checked regularly to make sure the home continues to be safe for the people who live and work there. EVIDENCE: The manager of the home has been in post for over two years. She confirmed that she has continued to maintain her registration as a registered general nurse and that she is in the process of completing her Registered Managers Award. She told us she is an NVQ assessor, which means that she can assess the competence of staff in the home who are working towards their NVQs. Other courses she has attended include manual handling assessor, four day first aid qualification and distance learning courses.
Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 22 During our visit, we spoke with people who live in the home, relatives and staff about the overall management of the home. They said the manager and owner are very approachable and ‘know what they are doing’. Staff said the manager gives them support, supervision and guidance on caring for the people who live in the home. Relatives told us the manager was ‘very welcoming’ when they first visited Thornton House and that she ensures they are kept informed of any incidents that affect their relatives who live in the home. People we spoke with who live in the home told us the manager regularly talks with them and that they know they can speak to her about anything they are worried about. They said they depend on their relatives to look after their affairs. The manager told us she gets feedback on the quality of the service provided at the home by speaking to the people who live in the home and their relatives. She also meets regularly with people who live in the home on an individual basis and in residents’ meetings. The activity co-ordinator talks with the people who live in the home and she gives feedback about any issues or concerns to the manager. These actions help to make sure that the people who live in the home are able to express their views about how it is running. Small amounts of money are kept on behalf of the people who live at the home. This is stored securely with only the manager and the owner having access, to make sure that accurate balances are maintained. We looked at a sample of maintenance and servicing records. These showed that systems in the home such as the boilers, the fire safely system and the chair lift are tested and serviced regularly, as required, to make sure they continue to be effective and safe for the people who live and work in the home. Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The current system for recording plans of care needs to be updated to make it easier for staff to follow to make sure they are meeting people’s needs in the way they prefer. Staff training, particularly on safeguarding adults, would benefit from input from external trainers to make sure that information about current best practice is made available to them. 2 OP30 Thornton House DS0000006545.V365006.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North West Region Unit 1, Level 3 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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