Inspection on 17/11/05 for Silver Threads

This inspection was carried out on 17th November 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Silver Threads 13/06/07

Silver Threads 04/07/06

Silver Threads 25/07/05

Silver Threads 10/01/05

Silver Threads 22/04/04

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Poldhu

Queensmount

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Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Silver Threads 1 Lyndale Terrace Instow Bideford Devon EX39 4HS Lead Inspector Jo Walsh Unannounced Inspection 17th November 2005 09:00 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 Silver Threads DS0000022162.V262902.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 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. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Silver Threads Address 1 Lyndale Terrace Instow Bideford Devon EX39 4HS 01271 860329 01271 860020 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 Robert John Flynn Angela Flynn Care Home 14 Category(ies) of Dementia - over 65 years of age (14), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (14), Old age, not falling within any other category (14) Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th July 2005 Brief Description of the Service: Silver Threads is situated in the village of Instow, between the towns of Bideford and Barnstaple. The homeowner aims to make every residents stay as comfortable as possible. Silver Threads caters for 14 service users over the age of 65 years, who may be physically or mentally frail. The property is an adapted three-storey terrace house and significant improvements have been made in the last four years. The accommodation is comfortable and homely. There is a stair lift to the first and second floors, with two communal lounges, a dining and reception area on the ground floor. There is also an attractive courtyard area with summerhouse for service users use. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, meaning the home were not made aware of the inspection date or time. The inspection took place during a weekday in November, starting at 9 am and finishing at 1.45. During this inspection 11 of the residents were spoken to and all of the daytime staff group, including the registered provider. Time was also spent looking around the home and reviewing some of the key documents including residents care plans, medication records, the fire log book and risk assessments relating to safe working practices. What the service does well: What has improved since the last inspection? The home had not followed up on many of the previous recommendations or requirements and as this was the first inspection completed by this inspector, it is difficult to comment on what had improved. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 6 Residents spoken to did not identify many areas for improvement. One resident did say they would like the opportunity to go out of the home more, but for the most part residents expressed a high level of satisfaction. 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. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 7 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 Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 The home provides good clear information about what new Service Users can expect from the home. Detailed assessments are completed prior to people moving into the home ensuring all needs can be met. Prospective service users are enabled to visit the home to help them make a decision about whether to move there. EVIDENCE: Copies of the Homes Service User Guide are made available in the communal areas. The information gives clear guidance as to what the home provides in terms of care and support. This information is made available to any prospective new residents to help them or their families make an informed decision about whether the home is right for them and can meet their individual needs. Three residents files were viewed and contained pre admission assessment information, demonstrating that the home make sure they are aware of individuals care and support needs prior to admission. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 9 Three of the residents spoken to confirmed that they had had the opportunity to visit the home prior to moving in and this helped them to decide that this was the right home for them. One resident stated that she had visited several times for day care prior to moving in and this made the transition easier. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Individual care plans provide clear information about health and care needs enabling staff to provide good quality care. Robust procedures are in place to ensure medications are safely administered. The arrangements for health and personal care ensure that resident’s privacy and dignity are respected at all times. EVIDENCE: Three care plans were viewed and discussed with a senior staff member. The plans detail individual needs in respect of health and personal care, but the home have still to implement the recommendations made form the previous inspections, which would enhance the plans and enable staff to work more consistently with individuals. It was also noted that personal details were sometimes recorded in the homes diary. This practice contravenes the data protection act, and the home are advised that all personal details should be recorded within the individuals own care plan/file. The homes medication records and procedures were viewed and discussed. The administration and recording is robust to ensure mistakes are not made, but the storage of medications does not meet the standards. All controlled Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 11 medications need to be stored in a controlled medications cabinet, bolted to the wall. Also any regular medications needing to be refrigerated must be stored in a separate locked fridge. Residents spoken to stated that they were treated with respect and dignity, that staff referred to them by their preferred address and always knocked on their door before entering. One resident stated ‘’the staff really look after you if you are not feeling well’’ Individual files show that health care professions visit the residents to ensure all health care needs are met. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The routines of daily living and the activities made available are flexible and suit individual’s needs and preferences. Visitors are made welcome and residents are enabled to maintain contact with family and friends. The home provides a good balanced diet, with plenty of choice and special requirements are catered for. EVIDENCE: Residents spoken to confirmed that the home provides activities most afternoons, including games crafts as well as occasional entertainers. There are two lounges so those not wishing to participate do not have to go to their own room. One resident did say they would like more opportunity to go out for walks. Several residents commented on how much they enjoyed the activities on offer and one stated that a special effort is made for Christmas. Most of the residents spoken to confirmed that visitors are made welcome, that they can either have their own phone line put in or call can be received via the homes phone, and a cordless phone was provided to ensure privacy. One resident said that the owner transported them each week so they could maintain contact with a close friend. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 13 Residents also confirmed that they are able to make their own choices about when to get up, where they chose to spend their time and that their individual preferences regarding meals was always taken into account. The mid day meal was sampled with residents. The meal was well presented, served in a relaxed and unhurried manner and people were offered choices. All of the residents spoken to stated they enjoyed their meals, comments included ‘’very tasty’’ ‘’always lots of it’’ ‘’you can ask the cook for anything and she will try to get it for you’’ All residents are provided with a weekly menu and staff remind them what is on offer each day. Meals are always cooked form fresh ingredients ensuring residents have a balanced diet Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 There is a complaints procedure in place, but this still needs to be simplified to ensure residents and their representatives are aware of who they can voice their complaints to EVIDENCE: The complaints procedure is evident in the home, as were leaflets from CSCI, however the owner has still not acted on previous recommendations to simplify the complaints procedure. Residents spoken to stated they were confident that they could talk to the registered provider or staff and their concerns would be listened to and dealt with. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,26 The location and layout is suitable for its stated purpose. The home is well maintained and homely and provides residents with a safe attractive and clean place to live, although the registered provider must ensure all risks regarding hot surfaces and hot water outlets are properly risk assessed. EVIDENCE: The home was found to be extremely clean and free from offensive odours on the day of the inspection. A tour of the premises was made and the registered provider was able to show documentation to demonstrate that equipment is well maintained. Residents spoken to stated they were happy with the décor of the home, which is attractively furnished in a homely fashion. Individual bedrooms were viewed and residents are encouraged to personalise their rooms and are enabled to bring in small items of furniture. The home does not provide locks on bedroom doors so cannot fully provide for privacy. The registered owner stated that all residents had signed to say they Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 16 did not wish to have locks fitted, but it was not made clear what would happen if an individual stated they did want a lock fitted. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 The home are working towards more staff being NVQ trained, but need to ensure there is regular training, including specialist training in dementia, to ensure staff can meet the complex needs of the residents. EVIDENCE: Staff training was discussed with the registered provider, who stated that they are working towards more than 50 of the staff group being NVQ trained and is about to do a course on dementia awareness along with his senior member of staff. It was agreed that this training must now be extended to all care staff to ensure they understand the needs of residents with dementia and have some training in current good practices for working with people with dementia. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35,38 The registered provider is qualified and experienced to run the home. Robust procedures are in place to ensure residents financial interests are safe guarded. Not all aspects of health and safety have been properly assessed and this could compromise the safety of residents. EVIDENCE: The registered provider has completed the NVQ 4 in care and management as well as the registered managers award. He has several years experience of running this home and residents spoken to stated that they believed he was approachable and would listen to their concerns. Records regarding individual transactions made on behalf of residents were viewed and discussed. They records are well maintained and accountable, with receipts kept. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 19 A number of records were viewed including the fire logbook, servicing on equipment and risk assessments. Risk assessments pertaining to risks from burns from radiators were general and not completed for each individual. Very few radiators were covered, and this could place vulnerable frail and confused residents at risk from burns. Likewise the risk assessments for hot water outlets were not completed for each resident, but rather one general one covering the home. To ensure residents are safe from scalding themselves, risk assessments must be completed for individuals, and where significant risks are identified, measurements put in place to minimise risks. The home does not have any hoisting equipment, and this places staff at risk if they need to assist someone to get up following a fall. The registered provider must ensure that safe working practices are in place at all times. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 20 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 3 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 17 X 18 X 3 X X X X 2 X 3 STAFFING Standard No Score 27 X 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 22 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 OP33 Regulation 24 (1)(2) Requirement You are required to establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home in consultation with service users and their representatives. The registered person shall supply to the Commission a report of the review and make a copy available to service users (Previous date set 08/11/05 The home must ensure that all controlled drugs are kept in a controlled drugs cabinet. The home must ensure medications needing to be refrigerated are kept in a separate locked fridge. The registered provider must ensure care staff has regular training in dementia care. The home must ensure risk assessments are completed for all individuals regarding risks from hot surfaces and hot water outlets, and where significant risks are identified, measures are put into place to reduce the risks. Copies of the risk assessments to be forwarded to the CSCI The home must ensure that all fire doors remain shut unless held open by an approved device linked to the fire alarm system. DS0000022162.V262902.R01.S.doc Timescale for action 30/12/05 2 3 OP9 OP9 13 13 30/03/06 30/12/05 30/03/06 30/12/05 4 5 OP28 OP38 18 13 6 OP38 13 07/11/05 Silver Threads Version 5.0 Page 23 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. 2. 3. 4. 5. 6. 7 Refer to Standard OP7 OP7 OP16 OP30 OP38 OP38 OP24 Good Practice Recommendations You are recommended to revise care plans to include aims, evaluation and outcome of care You are recommended to ensure care plans are comprehensive and demonstrate a follow through of identified needs You are recommended to simplify the complaints procedure to make it more user friendly, and to state that CSCI can be contacted at any time You are recommended to ensure staff receive training in dementia care You are recommended to ensure that the thermostatic controls on sink taps are in working order You are recommended to cover all radiators The home should provide locks on all bedroom doors, of a type that are easily accessible to staff in an emergency. Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Silver Threads DS0000022162.V262902.R01.S.doc Version 5.0 Page 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. 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