CARE HOME ADULTS 18-65
Thornhill Close (2) Dorchester Dorset DT1 2RE Lead Inspector
Marion Hurley Unannounced Inspection 13th December 2005 09:00 Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 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 Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 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 Adults 18-65. 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. Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Thornhill Close (2) Address Dorchester Dorset DT1 2RE 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) 01305 266589 NO FAX Leonard Cheshire Mrs Glynis Elizabeth Baker Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Mrs Baker to undertake an adult protection managers course (agreed suitable by the Commission) by September 2005. 23rd June 2005 Date of last inspection Brief Description of the Service: 2 Thornhill Close is a care home providing personal care and accommodation to three adults who have a learning disability. The home is one of seven similar services in Dorchester that are owned and operated by the Leonard Cheshire Foundation, a not for profit organisation providing services to people with disabilities. The registered manager is Mrs Glynis Elizabeth Baker, who is based at the providers local office in Alexandra Road, Dorchester. The home is located in a popular residential area of Dorchester, within walking distance of the town centre. Dorchester has a wide range of shops, banks, GP surgeries and other amenities, which are used by service users on a daily basis. The property is a single storey building. All service users have single bedrooms and share the communal lounge/diner, and kitchen. There is level access throughout and to the front and rear doors. Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection has been undertaken as part of the statutory inspection process in accordance with the Care Standards Act, 2000. Thornhill was assessed according to the Care Home for Adults (18-65) National Minimum Standards. The overall time spent to complete the inspection process was a total of five hours; one and half were spent at Thornhill. In the course of this inspection two members of the staff team and the Registered Manager were available and all the residents were at home. What the service does well: What has improved since the last inspection?
A comprehensive programme of staff training events has given staff opportunities to attend statutory training courses. New staff have successfully been recruited and benefited from comprehensive induction training. Since the last inspection members of the staff team and the Registered Manager have spent considerable time in developing and changing the written format of the Individual Service Plans. The new style reflects a Person Centred Approach to these documents and the reader gets a real feel of the person in addition to good practical information. The lounge diner has been redecorated and low surface temperature radiators have been installed throughout the home. Staff have successfully resourced another riding stables which matches the needs of the residents and this has proved very popular with those who regularly go horse riding. This piece of work was a positive indication that staff consider nothing is too much bother when working with and on behalf of the residents.
Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 6 What they could do better: 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. Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 • Service Users would only be admitted based on an assessment of their needs, ensuring the home would be able to meet the service user’s identified needs and have the appropriate staffing levels and facilities. EVIDENCE: Since the last inspection no new services users have been considered for Friars Close. The group of people living at this small family style home have done so for many years and a vacancy is not anticipated. In view of this the inspector discussed the principles of a prospective service user being considered for a placement with the Registered Manager. It was clear from these discussions that their knowledge and understanding of good working practices would ensure any prospective resident and or their representative would be involved in a comprehensive assessment to identify their specific needs. Many of the prospective service users considered for the Cheshire Home Service have complex needs and very individual methods of communicating and in reality it might take months to complete a full assessment of the persons needs, preferences and wishes. Records relating to the resident’s needs indicated the staff’s ability to seek advice and work as part of a multi agency network obtaining specialist assessments where appropriate. It is anticipated any prospective service user would benefit from this comprehensive approach. Prospective service users would always be involved and the admission process would be based on the individual’s ability to cope with the transition of moving into a new situation.
Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The key standards were not assessed having been met at the previous inspection. Please note a good practice recommendation from the previous report has been fully actioned with reference to the Individual Service Plans. The records of one service user were read and these reflected the change in style of formulating the resident’s Individual Plans which are now Person Centred and holistic providing the reader with a feel of the person’s wishes, abilities and needs. Staff are currently working of changing the format of the risk assessments and writing them specifically for the individual resident. EVIDENCE: Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 & 17 • Staff ensure residents are supported in maintaining contact with family members and in developing appropriate friendships. • Meals are healthy and mealtimes flexible to suit residents lives. EVIDENCE: The evidence for these standards was obtained from discussion with staff and from reading the Individual Plans of one resident. There was good evidence of regular liaison recorded in the resident’s file including contact details and birthdays. Residents maintain contact in various ways some through regular phone calls, others through regularly sending postcards and others enjoy visits and outings. Residents are helped by staff to ensure these contacts are appropriately maintained. Residents are friends with other service users supported though the Cheshire Home Services and also benefit from regularly meeting with their peers at Social and Education Centres. One resident enjoyed a holiday with a resident from another Cheshire Home in Dorchester and this arrangement worked very well with both people having a good holiday sharing their interests. Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 11 The menu is planned a month in advance and whilst it does not show specific choices there is always an alternative available. Staff know the resident’s like and dislikes and adjust the menu accordingly. Staff are keen to encourage healthy living and the menu was balanced and with a good variety of meals. Ample fresh fruit and juices are consumed daily. The refurbishment of the kitchen and utility room is still not completed and this has made it extremely difficult for staff to involve residents in the preparation of any meals. However, once this work is completed the residents will again be encouraged to be involved as far as practical in participating in activities in the kitchen and assist in the choice of their meals. Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The key standards were not assessed having been met at the previous inspection. EVIDENCE: Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 • Staff listen and encourage all the residents to try and express their own views and opinions. However, for much of the time staff have to observe and interpret behaviour to judge the views of the residents. EVIDENCE: Staff spoke of the different styles each resident has for expressing their views and feelings. Although there are no formal resident meetings there are regular house/staff meetings in which residents may join in and contribute in their own way. For some residents this may just involve observing the proceedings. Staff are experienced at understanding the behaviour and different sounds each resident makes to display their emotions for example one person squeals when they are very happy, whilst another will sometimes grind their teeth in their efforts to indicate to staff things are not as they wish. From discussions with staff it was evident they had a very positive understanding of the residents living a Thornhill and did their best to ensure the wishes of the residents were uppermost. Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 • Despite the best efforts of staff the standard of cleanliness is not high at the present time but this is significantly due to the fact that the work in the kitchen and utility rooms remain on going and the bathroom is in urgent need of refurbishment. EVIDENCE: Thornhill is a small family style home and when there is so much disruption in two rooms it has been very hard for staff to maintain standards. However, despite this the home was reasonably clean and it was only when going into the bathroom, kitchen and utility rooms was there evidence that these rooms were not being kept up to the rest of the home’s standards. Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 • Residents are protected by the employment procedures and the staff training programme, which is comprehensive and covers all aspects of the statutory training. EVIDENCE: The Registered Manager and two members of the staff team each talked confidently about the needs and preferences and wishes of the different residents. Both had clear insight into the different styles of communicating each resident use. Brief observations made on the day of the inspection indicated how well staff and residents get on and there appeared to be a positive and open relationship. Residents were unable to verbally confirm these indications but there is no question that through their individual communication and specific behaviour each would clearly indicate any negative feelings they might have towards staff - none were observed. All staff files are retained at Cheshire Homes main Dorchester Office and three files were checked when visiting these administrative offices. Each file contained the required statutory checks and references. Both POVA first and an Enhanced CRB check had been received plus two references. Identification and a photograph was found in each file along with completed interview notes, “letter of offer of employment”, terms and conditions/contract.
Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 16 A useful checklist was at the front of each file and had been completed in each case. An induction/training checklist was found completed in two out of the three files and those completed confirmed which policies and procedures had been provided to the new recruit. Staff training is provided on a rolling programme and a Training Newsletter has recently been circuited confirming which staff have been nominated for the next round of training events. The training programme includes the following: - Health & Safety, Food Hygiene provided by West Dorset District Council, LDAF induction, POVA first, and Care of Medicine Foundation course. Staff for these courses are nominated from all the homes managed through Cheshire Homes Dorchester. Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 • Health & safety checks are adequate and these contribute to safe working practices to protect residents and staff living and working at the home EVIDENCE: The responsibility for checking the health and safety equipment and servicing records is with the maintenance employee who is based at the Cheshire Homes Administrative Offices, Dorchester. Each home has a generic work base file containing risk assessment and these are reviewed. Other documents relating to individual staff fire prevention training are collated at the Administrative offices and kept with other training records in individual training files. The “responsible individual” representative for Cheshire Homes completes the monthly monitoring visits, Regulation 26 and these reports are comprehensive and extremely useful and practical in providing on going information. Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score 3 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x x x x x Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x 3 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score x 3 x x x x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Thornhill Close (2) Score x x x x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x DS0000026745.V266702.R01.S.doc Version 5.0 Page 19 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. 1 Standard YA24 Regulation 23(2)(b) Requirement The home should ensure that furnishings, fittings, adaptations and equipment are good quality and are as unobtrusive and ordinary as is compatible with fulfilling their purpose. Refurbishment work on the kitchen, utility room and bathroom are urgently needed. At the previous inspection it was understood these would be completed in 2005. The home must establish and maintain a system for reviewing and monitoring the quality of care provided by the home and where possible involving residents or their representatives. Timescale for action 31/03/06 2. YA39 24 31/03/06 Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 20 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 YA20 Good Practice Recommendations All staff administering and handling medication must receive accredited training in basic knowledge of how medicines are used, how to recognise and deal with problems and the principles behind all aspects of the Homes policy on medicines. At the time of this inspection aspects of this recommendation were actively being addressed. Thornhill Close (2) DS0000026745.V266702.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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