Inspection on 28/07/06 for 2 Thornhill Close

This inspection was carried out on 28th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

2 Thornhill Close 13/12/05

2 Thornhill Close 23/06/05

2 Thornhill Close 22/12/04

2 Thornhill Close 04/08/04

2 Thornhill Close 05/01/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Thornhill Close (2) Dorchester Dorset DT1 2RE Lead Inspector Marion Hurley Key Announced Inspection 28th July 2006 09:30 DS0000026745.V296620.R01.S.doc Version 5.2 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 DS0000026745.V296620.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 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. DS0000026745.V296620.R01.S.doc Version 5.2 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 www.leonard-cheshire.org.uk Leonard Cheshire Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places DS0000026745.V296620.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2005 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 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. All residents have single bedrooms and share the communal lounge, separate dining room, small kitchen and separate utility room, bathroom and WC. The home is staffed 24 hours a day. The Organisation also provides structured day care to service users, at an extra cost to the residential fees. Fees are individually negotiated according to the residents needs. Copies of inspection reports are available upon request from the Leonard Cheshire Home administration Office in Dorchester. DS0000026745.V296620.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place over a period of three hours and was completed as an announced inspection. Two members of staff were on duty and all three residents were at home for part of the time with one resident being present throughout the inspection visit. The inspection methods used included checking records, case tracking, incident reports, regulation 37 reports and discussion with staff and observations of their relationships and communication skills with the residents. At the time of this inspection this home does not have a Registered Manager or allocated team leader. However, the Regional General Manager advised that the organisation would shortly be recruiting for the team leader post. No additional visits have been undertaken since the last inspection in December 2005. There have been no reported accidents or incidents and no complaints or concerns have been raised internally or to the CSCI. Three comment cards were returned with no significant concerns. A pre inspection questionnaire was sent on May 23rd but not completed or returned prior to the inspection. What the service does well: The daily routines of the home are designed to involve residents in choosing how they spend their time. Staff spoke of taking residents bowling, horse riding, shopping and going to premier football and rugby matches. Residents are given every opportunity to participate in activities of daily living and where they are physically unable to do the task staff continue to involve them through residents being there whilst the task is completed with staff providing the explanation and commentary of what they are doing. An example of this would be when cooking meals the residents may sit in the kitchen and watch or be involved as far as they are able. The home has a core group of staff with many years experience. They appear to understand the residents’ needs and provide consistency of care. Residents appeared happy and relaxed and “well looked after” with the home offering a friendly and homely service to its residents. DS0000026745.V296620.R01.S.doc Version 5.2 Page 6 The home was clean, fresh and tidy. The choice of food on offer is nutritious and appealing. What has improved since the last inspection? 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. DS0000026745.V296620.R01.S.doc Version 5.2 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 DS0000026745.V296620.R01.S.doc Version 5.2 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 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been no recent admissions to the home. Placement assessments have not been reviewed. Each resident must have a written and signed contract and or terms and conditions. EVIDENCE: At the last inspection it was identified that not all residents had written statement of terms and conditions and a requirement was set regarding this. This requirement has not been met. At the time of this inspection the home has no Registered Manager or team leader. The two staff on duty, one of whom has been acting team leader, were unsure of the Leonard Cheshire admission policies and procedures but did describe what would be considered good practice to introduce someone new to this group. DS0000026745.V296620.R01.S.doc Version 5.2 Page 9 The Service Manager has previously managed all referrals and admissions involving staff only on a practical level. No change is anticipated within this long-standing group of residents who have lived together for over 10 years. Residents’ needs are not formally kept under review and no goals are set or records of achievement recorded. DS0000026745.V296620.R01.S.doc Version 5.2 Page 10 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): 6, 7, and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning system is being improved. Residents are assisted to make decisions about their lives. Residents are consulted and staff try and encourage their participation in all aspects of life in the home. EVIDENCE: At the last inspection it was identified that care plans did not reflect all the assessed needs of residents and that risk assessments need to be evolved in conjunction with the care and support plans; this has not yet been fully achieved. One care and support plan was examined in detail and staff have made clear efforts to produce the document in a more “user friendly” format using some DS0000026745.V296620.R01.S.doc Version 5.2 Page 11 symbols and words. However, many of the pictures appeared rather dated and child like e.g. “play and leisure”. Staff still need to consider different ways to make at least one section of the resident’s plan more accessible. There was on going evidence that the home work in a consultative way with other professionals to improve the lives and care of the residents. Support staff provide care to residents appropriately. This was assessed through discussion with staff and observation. Staff involve residents as far as possible in every aspect of their lives and have developed positive relationships with them. Fortnightly staff meetings are held when each resident is discussed briefly and notes from these discussions are added to their care plans. This covered activities, outings, menu planning and household routines. Residents have limited verbal communication and staff rely mostly on other forms of communication. It is therefore very important that the records show how residents are not just consulted but also actively involved in all aspects of life at the home and a record of achievable goals set and accomplishments recorded. DS0000026745.V296620.R01.S.doc Version 5.2 Page 12 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): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home seeks to provide residents with opportunities for personal development and to enjoy a wide range of activities. Residents are part of the local community. Residents are offered a healthy diet and enjoy meals and mealtimes. EVIDENCE: One resident was at home throughout the inspection visit and during that time enjoyed a massage. Other activities are pursued away from the home e.g. reflexology, pedicures in addition to the more physical activities of horse riding and swimming, walking, shopping and having meals out. All the residents take part in community-based activities rather than attending day services for people with disabilities. DS0000026745.V296620.R01.S.doc Version 5.2 Page 13 Each resident has an activity chart /timetable and staff need to consider ways to develop this to demonstrate how each resident is involved in the planning of their chosen activity. Staff described what each resident enjoys from the different activities they participate in. However, it would be beneficial if this information was recorded and linked to other aspects of the resident’s life and well being. All local mainstream health care, opticial and dental surgeries are accessed. Support staff prepare all the meals and are required to complete the training course in basic food hygiene. The kitchen was found to be clean and tidy and all appropriate records had been completed. Menus were seen and these showed a good variety of choice and a record of meals consumed are logged in each resident’s diary. DS0000026745.V296620.R01.S.doc Version 5.2 Page 14 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): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place to ensure that support staff know how to meet the residents health care needs in a safe way. Staff are appropriately trained. EVIDENCE: The resident’s file reviewed provided written documentation relating to personal and health care and there were clear records of appointments and outcomes with other professionals. However, the file did not contain evidence or demonstrated how staff had reached the decision how the resident preferred to receive their personal care. Some staff have first aid qualifications. All members of staff are involved in the administration of medicines and the two staff on duty confirmed that they had received specialist training. Records of drug administration were viewed and were satisfactory as were storage arrangements and stock levels. DS0000026745.V296620.R01.S.doc Version 5.2 Page 15 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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable staff to complain about the service and to contact outside agencies for support. Procedures are established for the reporting and recording of any potential abuse. There have been no complaints received internally or directly to the CSCI Offices. EVIDENCE: There is a complaints procedure available at the Leonard Cheshire Homes Dorchester Administration Offices. This document has not been reviewed since 2004, and needs amending to include the contact details of the local CSCI offices. It is the practice of the Leonard Cheshire homes that either the Service Manager or Regional General Manager would deal with any concerns or complaints or issues relating to suspected abuse. It is therefore important that all members of the senior management team are familiar with the procedures especially relating to the protection of Vulnerable Adults and how these link into the local authority multi-agency adult protection procedures. The protection of vulnerable adults is covered as part of all staffs’ induction. DS0000026745.V296620.R01.S.doc Version 5.2 Page 16 It was noted that body maps were used to record any marks noted on the residents’ body and this information cross referenced with details recorded in the resident’s diaries and care/support plans. All residents have their own bank accounts but are reliant on the staff to manage their monies. There are clear records of all financial transactions completed with and on behalf of each resident. There was no complaints record in the home. DS0000026745.V296620.R01.S.doc Version 5.2 Page 17 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): 24, and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were relaxed and at ease in the home environment, which was clean, comfortable and satisfactorily maintained. The home benefits from being kept clean and hygienic. EVIDENCE: A tour of the home was undertaken and no immediate hazards were identified. However, one potentially serious hazard was drawn to the inspector’s attention by the staff who described how when the cooker is in use the side cupboard becomes extremely hot to the touch. Staff advised this fault had been reported. The communal dining room /lounge is of a reasonable size allowing residents to have sufficient space to do their own thing. Good use of the bedrooms has been made and the rooms are individualised and decorated in a thoughtful way. DS0000026745.V296620.R01.S.doc Version 5.2 Page 18 The home has a small separate utility/ laundry room. The garden is a safe space for the residents to use and in the summer months this extra space impacts in a positive way on the daily lives of residents. All staff share the responsibility for keeping the home clean and hygienic and doing the residents’ laundry. DS0000026745.V296620.R01.S.doc Version 5.2 Page 19 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, 34, and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected by the Home’s recruitment policy and practices. However, residents’ safety was being compromised by an inadequate frequency of fire training for staff. EVIDENCE: The staff rota was seen and this showed sufficient numbers of staff, there is no hierarchy in the staff team and everyone undertakes all the household responsibilities. Staff training records were seen and these showed that there was plenty of relevant training available for staff. Two staff files were examined and were found to contain all elements required by current regulations, regarding recruitment practices. The files provided evidence of induction training to Learning Disability Award Framework (LDAF) standards and all references and required checks for recruitment. DS0000026745.V296620.R01.S.doc Version 5.2 Page 20 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): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a general relaxed atmosphere with the interests of the residents kept to the fore; however, these could be further enhanced through a more structured approach to monitoring the quality of services. Residents’ health, safety and welfare were being protected. However a lack of fire training for some staff potentially places both residents and staff at risk. EVIDENCE: The responsible person representing Leonard Cheshire Homes undertakes monthly monitoring visits (Regulation 26) and these comprehensive reports are sent regularly to the CSCI offices. DS0000026745.V296620.R01.S.doc Version 5.2 Page 21 The staff demonstrated a sound knowledge both of the residents’ individual needs and how they are suitably supported and managed in a communal setting. Staff regularly discuss any issues concerning the residents or staffing issues at the fortnightly staff meetings and informally monitor the care and services provided. However, a formal quality assurance system needs to be established by the Leonard Cheshire Homes. There were no obvious hazards noted within the home except for those previously identified. (NMS 24) Other health and safety checks and servicing records were all satisfactory. Residents’ records were safely and securely stored. From observations of the residents, it would seem that they felt comfortable in the home and were looked after by staff who cared and understood their needs and responded to them. DS0000026745.V296620.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 X 2 2 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 2 X X 2 x DS0000026745.V296620.R01.S.doc Version 5.2 Page 23 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 YA5 Regulation 5(1)(b)(c) Requirement The registered provider/manager must ensure that all residents have a written and costed contract/statement of terms and conditions. The registered provider/ manager must develop and agree with each resident an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. The plan must be reviewed at least every six months and updated to reflect changing needs. The registered provider/manager must ensure that all parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety. The home’s premises must be accessible, safe and well maintained. DS0000026745.V296620.R01.S.doc Timescale for action 30/11/06 2. YA6 15(1) (2) (a)(b) (c) (d) 31/10/06 3 YA24 13(4) (a) 30/11/06 Version 5.2 Page 24 4 YA37 8(1) 9 (1) (2) 5 YA39 24 (1) (2) (3) 6 YA42 23 The registered provider must 30/11/06 appoint a manager who is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives Effective quality assurance and 30/11/06 quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home The registered / provider 31/08/06 manager must ensure all staff receive fire training within the required timescales RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000026745.V296620.R01.S.doc Version 5.2 Page 25 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 © 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 DS0000026745.V296620.R01.S.doc Version 5.2 Page 26 - 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. 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