Inspection on 25/07/05 for Silver Threads

This inspection was carried out on 25th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Silver Threads 13/06/07

Silver Threads 04/07/06

Silver Threads 17/11/05

Silver Threads 10/01/05

Silver Threads 22/04/04

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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 EX39 4HS Lead Inspector Sue Dewis Annual Inspection 25 July 2005 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 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 D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Silver Threads Address 1 Lyndale Terrace, Instow, Bideford, Devon 01237 860329 01237 860020 Telephone number Fax number Email 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 J Flynn Care Home 14 Category(ies) of DE(E) Dementia - over 65 (14), registration, with number MD(E) Mental Disorder - over 65 (14), of places OP Old Age (14) Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10 January 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 resident’s 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 D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over one day towards the end of July 2005. The inspector received comment cards from nine visitors and 10 residents; a pre-inspection questionnaire had been completed by Mr Flynn and sent to CSCI prior to the inspection. A tour of the building was made and the inspector spoke with three staff in a group setting. The inspector also spoke with a total of six residents. What the service does well: What has improved since the last inspection? What they could do better: Neither staff nor residents could identify any area for improvement, other than one resident felt that they would like lunch to always be served at 12 noon. Most of the items identified during the inspection were of a minor procedural nature and did not raise any immediate concern. Care plans could be improved by more clearly setting out how staff will meet the day to day needs of residents and resident risks could be further minimised by ensuring radiators Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 6 are covered and thermostatic control valves fitted to sinks are working correctly. As there are several residents who have dementia it is recommended that staff receive some specialist training in caring for people with this particular need. The home does not have a formal system for reviewing the quality of care and a system must be established with reports sent to CSCI. Though all residents said that they felt they could talk to staff and Mr Flynn, a simplified complaints procedure would ensure anyone wishing to raise a concern with CSCI could more easily do so. 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 D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 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 standard(s) 3 There is full assessment prior to people moving into the home, giving an assurance that care needs will be met. EVIDENCE: Four residents’ plans were inspected and all contained detailed pre-admission assessments. The inspector was told that depending on the situation either Mr Flynn will visit the prospective resident or they will visit the home. The preadmission assessment is completed on the first meeting. Prospective residents may visit the home for as long as they feel they need to make a decision, and many have known other residents at the home. Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7, 8 and 9 There is a clear and consistent care planning system in place to generally provide staff with the information they need to satisfactorily meet the needs of the residents EVIDENCE: Four residents’ plans were inspected. There had been two recommendations made at the previous inspection, suggesting that aims, evaluation and outcome of care be incorporated. It was also recommended that care plans be comprehensive and demonstrate follow through of the needs. These recommendations had not been acted upon and while Mr Flynn wishes to carry on with the current plans the recommendations will continue from this report. Bearing in mind the above recommendations, the plans contained good details of the resident’s abilities and are reviewed each month. Assessments for risks, falls and manual handling had been completed. The home is involved with the North Devon Falls Prevention Scheme, and all residents have been assessed through this. Records of doctors and district nurse visits were seen. Other health professionals including physiotherapists, occupational therapists and dentists visit as required. Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 10 Four staff have recently received assessed training in the safe handling of medicines. The Boots MDS (Monitored Dosage System) is used and the local pharmacist visited on 23 March 2005. While policies and procedures were seen to be appropriate it is recommended that a list of specimen signatures and initials of staff who administer medications is obtained. This would enable easier identification of staff who administered a specific dose. Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12, 13 and 15 Social activities that are offered provide stimulation and interest for residents. Residents are able to maintain contact with family and friends. Meals are nutritious and offer a healthy and varied diet for residents. EVIDENCE: On the afternoon of the inspection an entertainer visited the home. Residents said that he had visited before and that they always enjoyed his visits. An activities organiser is employed at the home and visits each day. Mrs Flynn also visits most days and spends time chatting with the residents. Several residents said that they enjoyed spending most of their time in their rooms, coming out for meals and activities. The inspector was told by residents that they had lots of visitors who were always made welcome. This was echoed by the responses on the visitors’ comment cards, who all said they were always greeted in a friendly way. The inspector was told that the home was well integrated into the community and that one neighbour often invited residents into her garden for tea. Lunch was eaten with residents, and it was well presented and nicely cooked. Menus showed a varied and balanced diet on offer. Residents said that the food was very good and as lunch was the main meal, the tended not to want too much for tea. Menus for the week are given to the residents so that they can say if they want something else. Drinks are available at any time. Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 16 and 18 Staff training ensures residents are protected from abuse. The complaints procedure needs to be simplified to more enable any complainant EVIDENCE: There is a complaints procedure for the home, and residents said they would talk to staff or Mr Flynn if they were unhappy about anything. However, the procedure is rather complicated and says that complainants should not contact CSCI until the matter has been investigated internally. The procedure should be simplified, made more user friendly, and clearly state that CSCI can be contacted at any time. Mr Flynn has recently completed approved POVA (Protection of Vulnerable Adults) training, and has trained the care staff at the home in Adult Protection issues. All staff have also seen an abuse awareness video, and were able to discuss with the inspector, different types of abuse and the action to be taken if they suspected abuse was occurring. Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19, 23 and 26 The standard of the environment within the home is good, providing residents with a safe, attractive and homely place to live. EVIDENCE: The home was flooded earlier in the year and the ground floor has now been refurbished to a high standard. There is a homely atmosphere through the home and it is pleasantly furnished and decorated in a domestic manner. All bedrooms are for single occupancy and each reflected the personality of the individual occupant. Residents told the inspector that they had been able to bring some of their treasured possessions with them when they had moved into the home. Following a recommendation from the previous inspection, liquid soap and disposable gloves and aprons are available throughout the home. The home was very clean and hygienic and there were no offensive odours anywhere. Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The deployment and numbers of staff available throughout the day are sufficient to meet the needs of the residents. Residents’ needs are met by well-motivated staff. Training needs to be increased in order to better meet the needs of residents with dementia EVIDENCE: There are two care staff and one cook on duty each day, and one care staff awake and one sleeping in at night. Mr Flynn is at the home each weekday and there is a domestic at the home three days a week. Three staff files were inspected and all contained the required information except that one member of staff had refused to allow a copy of their birth certificate to be retained at the home. All contained satisfactory CRB (Criminal Records Bureau) checks. Staff have not received a lot of formal training this year, though two are waiting to start NVQs. It is recommended that staff receive some training in caring for residents who have dementia. Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 38 The home is well managed and this results in practices that generally promote and safeguard the health, safety and welfare of the residents. EVIDENCE: Mr Flynn has NVQ 4 (care) and the RMA (Registered Managers Award), and has been running the home for several years. There is no formal system to evaluate the quality of care at the home, though there are some questionnaires for residents and visitors. The home must establish a system for reviewing the quality of care at the home, send a copy of this to CSCI and make it available to residents. The home is registered with Data Protection and records are maintained according to the principles. Regulation 37 notices are now being sent to the home as necessary. Residents’ finances were looked at and were found to be well maintained. Records showed running balances and while two signatures were not evident, separate receipts are obtained/given as necessary. Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 16 Restrictors are fitted to windows above ground level and thermostatic control valves are fitted to bath taps. Controls are also fitted to sink taps but some are not working correctly and water was still running very hot. Mr Flynn is to attend to this. Not all radiators are guarded; though they have all been risk assessed and can be individually controlled. It is still recommended that all radiators be covered. Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x 3 x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 2 x 3 x x 2 Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 18 No Are there any outstanding requirements from the last inspection? 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 OP 33 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 Timescale for action 08/11/05 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. Refer to Standard OP 7 OP 7 OP 16 OP 30 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 D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 19 Silver Threads 5. 6. OP 38 OP 38 You are recommended to ensure that the thermostatic controls on sink taps are in working order You are recommended to cover all radiators Silver Threads D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Suite 1, Renslade House Bonhay Road Exeter EX4 3AY 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 D54-D06 S22162 Silver Threads V232783 250705 Stage 4.doc Version 1.40 Page 21 - 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. 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