Inspection on 04/07/06 for Silver Threads

This inspection was carried out on 4th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 17/11/05

Silver Threads 25/07/05

Silver Threads 10/01/05

Silver Threads 22/04/04

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Belma

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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 Devon EX39 4HS Lead Inspector Andy Towse Key Unannounced Inspection 4th July 2006 08:50 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.V293387.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 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.V293387.R01.S.doc Version 5.2 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. The fees charged at this home range from £350--£400 per person per week. Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The information contained in this report was obtained from discussions with staff, residents, visiting relatives and the manager during the inspection. This information was complemented by written responses from ten residents and four care workers to questionnaires forwarded by the inspector prior to the inspection. This is a small home, which is domestic in size. From the onset of the inspection there was an informal, friendly atmosphere in the home with residents clearly at ease with staff members. Further observation combined with conversations with residents, staff and visitors confirmed that this was the norm. What the service does well: What has improved since the last inspection? The medication trolley has been made safer by being secured to the wall, and there is now a separate, locked refrigerated facility for medication, which requires it. Some staff have now received specialist training in dementia care, which was arranged by a Health Authority professional. This comprised 8 training sessions, which is to be repeated to ensure that more staff are able to care more effectively for those residents who have dementia care needs. To safeguard the safety of residents the practice of wedging open fire doors has now stopped. Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 Page 6 The complaints procedure has now been amended to state the CSCI can be contacted at any time during the complaints process. The registered manager confirmed that thermostatic controls on sink taps are in working order. 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.V293387.R01.S.doc Version 5.2 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.V293387.R01.S.doc Version 5.2 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): 3, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s admissions process allows residents to make an informed choice about moving into the home whilst also ensuring that their needs are assessed and can be met. EVIDENCE: The files of three residents were examined and case tracked. One of the files belonged to a recently admitted resident. This showed that the home’s admission procedure included a visit to the home to allow the person to make an informed choice about whether or not to move into the home. The home’s admissions policy was seen to be very resident focussed and includes instructions to staff about ways in which they can reduce the level of stress experienced by people when they first come into care and make the experience more enjoyable. One resident of longstanding said that she had made the choice of moving into Silver Threads because she ‘liked the look of the place and the people are all very friendly here.’ Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 Page 9 All files examined were seen to contain assessments. The home has also been proactive in seeking support and information from relatives in drawing up assessments and in one instance an assessment was seen to have been drawn up by the manager using information obtained through discussion with close relatives who had previous involvement in this person’s care. Silver Threads does not offer intermediate care. Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health is well protected by the involvement of health care professionals and the formulation of care plans. In order that residents’ privacy is protected care plans should be kept securely. EVIDENCE: Inspection of files showed that all residents at Silver Threads have care plans. These were seen to have been generated from the assessments, which had been compiled when the resident was admitted to the home. The home also liaises with relatives of residents in order to draw up detailed biographic profiles, which result in staff having a more knowledge of the residents and an appreciation of who they are. Care plans were comprehensive, and, in addition to making reference to individual resident’s health and personal needs, they were seen to include regular reference to individual choice and preferences. Examples of this were preferred times of bathing, how many pillows a resident preferred, sleeps with night light and tea should be fairly strong with no sugar. Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 Page 11 Files were seen to contain risk assessments. The home has a written policy for the administration, storage and handling of medication. Since the last inspection the lockable trolley in which medication was stored had been made safer by being secured to the wall. The home uses a monitored dosage system of medication administration. At the time of the inspection there was no resident prescribed controlled drugs. Should any person be prescribed this medication the manager agreed that the separate lockable container would be secured inside the drugs trolley in compliance with the required storage of such medication. Since the last inspection the home has obtained, in response to a requirement made, a separate fridge, which is used solely for the storage of medication. Whilst most residents do not take responsibility for their medication, in instances where this does occur it is risk assessed and referred to in care plans. Staff receive appropriate training, both in-house and from external trainers in the administration of medicines. A record is kept of unused medication, which is returned to the pharmacy. Inspection of residents’ files showed that their welfare was safeguarded by there having access to relevant healthcare professionals. This written evidence was confirmed by the response of one resident to a questionnaire when he/she replied that the ‘general practitioner visits the home regularly and checks all the residents.’ It was seen that residents’ care plans were kept in an open filing cabinet in the dining room. This does not protect the residents’ privacy or ensure that their privacy is protected, files should be held more securely. Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents find that the lifestyle they experience in the home matches their expectations. Residents are encouraged to maintain contact with friends and relatives. A varied and nutritious menu is provided by staff knowledgeable about residents’ individual preferences. EVIDENCE: The home makes considerable effort to obtain information about residents’ interests. This information is sought through discussion with both residents and their relatives and when obtained is entered on their files. Residents are encouraged to be as active as they are able and every afternoon the registered manager’s wife arranges in-house activities for residents. On the day of the inspection six residents were seen actively involved, with staff support, in an indoor ball game. They appeared to be enjoying themselves, and interacted well with each other. Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 Page 13 Within the home residents clearly had autonomy about where they went and what activities they engaged in. One resident was seen to be setting tables prior to meals being served The home welcomes contact with the relatives and friends of residents. During the course of the inspection three residents were seen to be entertaining visitors. All visitors appeared to be at ease visiting the home, and conversation with one confirmed that visitors were made welcome at any time and that the manger and staff were approachable should discussion about care or advice be needed. Mealtimes were observed to be relaxed, with residents being able to decide where to eat. Before and during the meal there was friendly and lively banter between staff and residents. Residents appeared to enjoy their food and of the nine responses from residents received prior to the inspection, eight said that they either always or usually enjoyed meals in the home, with comments such as ‘he seems to enjoy his food’ and meals are very good here.’Examples were given of instances where residents’ choices had been discussed and added to the menu. Kitchen staff were spoken to. They were very aware of the individual likes and dislikes of residents. Although the menu did not show alternatives, these were seen to be available and reference was made to them on a notice displayed on the notice board in the dining room. The times of meals were discussed and it was found that mealtimes had been arranged to suit the preferences of residents. On the day of the inspection the catering was seen to include much fresh vegetables and fruit. The cook confirmed that vegetables and fruit were obtained daily from a local shop. Residents spoken to were very positive about the food available, with one resident with limited communication abilities writing, ‘A BIG YES’ when asked about whether she like the food at the home. Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s complaints system and staff having received appropriate training EVIDENCE: Responses from both residents and their relatives showed that they had confidence in approaching the owners and the senior mangers if they wished to raise any complaints or if there was anything about the service which they were not happy about. Comments from relatives and residents included the management being ‘very approachable’ and ‘I would speak to Bob Flynn if I was not happy.’ The home’s complaints procedure has been amended since the last inspection so that it now includes the right of the complainant to approach the CSCI at any time during the complaints process. The home also has a whistle blowing policy, which serves to protect staff that report poor practice. Copies of the complaints procedure were seen to be prominently displayed. Residents are further protected by staff having received training relating to the protection of vulnerable adults. Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 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, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, clean and well-maintained environment and have access to safe and comfortable indoor and outdoor communal areas. EVIDENCE: Silver Threads is an older type terraced property indistinguishable from other residential properties surrounding it, but deceptive in size. It is on three floors which can be accessed either by stairs of chairlifts. It offers its residents a choice of different lounge areas. All bedrooms are single occupancy, with nine of the fourteen bedrooms having ensuite facilities. There was a high standard of hygiene and cleanliness throughout the home. This was commented on by professionals and residents and their relatives in the pre inspection questionnaire, and by residents and their relatives during the inspection. Comments made were,’ it’s always fresh and clean’, ‘it is so beautifully clean and fresh’ and ‘the home is kept spotless always.’ Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 Page 16 Bedrooms were seen to have been personalised and it was observed that residents were free to use their rooms at all times and decided who else was free to enter them. All bedrooms were seen to have lockable storage space where residents could safely deposit money or valuables. Whilst radiators were in general not safety guarded the registered manager said that the safety of residents was ensured by the radiators having guaranteed low temperature surfaces and the added protection, in most rooms, of a chair being placed in front of them. The laundry is separate from the main building, situated away from areas where food is prepared and eaten. Externally the home has a private and enclosed courtyard, which was easily accessed by residents and was seen to be used by them during the inspection. Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 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): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are in safe hands at all times and are protected by the home’s recruitment policies and practices. EVIDENCE: Rotas provided showed that there are usually four care staff and a manager on duty on weekday mornings and at least two staff and a manager during the afternoons. Over night the residents’ needs are met by two staff, one of who is on wakeful duty. At weekends there are two care staff on duty in the mornings and a minimum of two in the afternoons and evenings. Discussion with the manager confirmed that he considered this to be appropriate to meet the needs of the residents and he showed evidence that staffing levels are increased when the needs of residents merited it. Due to the recent departure of three staff the home does not currently have 50 of its staff with NVQ II qualifications as expected by the National Minimum Standards. Currently it is less than 20 , however with two staff due to qualify in September and at least one other about to commence training, the home should achieve the level of staff training required by the Commission for Social Care Inspection within a year. Since the last inspection staff at the home have received specialist-training relating to the care of people who have dementia. This is complemented by the Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 Page 18 ‘Quality Dementia Care in Care Homes’ manual published by the Alzheimer’s Society. Staff were aware of this manual which was available at the home and which some had used as appoint of reference. The registered manager is planning for more staff to attend the 8-session dementia training run by a health professional. Staff files were examined to see whether the home’s recruitment policy safeguarded residents. All files examined were seen to contain police clearance checks. The files of staff recruited by the current registered manager were seen to contain police checks and two written references, application forms and job descriptions. The use of formal interviews, written references and the obtaining of police checks serves to protect residents and in discussion staff referred to undergoing a three month probationary period in which their suitability to work with older adults was assessed. The files of recently employed staff were seen to contain formatted induction programmes, and there was monitoring of the ongoing development of staff through formal appraisal. The registered manager also used formatted sheets for staff to evaluate the training he had made available to them. In discussion, those staff spoken to considered that staffing levels were adequate to meet the needs of residents and also considered that they had not been asked to perform work tasks outside their areas of expertise. Staff were also aware of the need to protect the dignity and privacy of residents and gave examples of how they ensured that the privacy of residents was protected. Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 Page 19 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, 33, 35,36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from being in a well run and managed home where risk assessments are undertaken to ensure their safety. Home EVIDENCE: The registered manager was present throughout the inspection. In discussion he demonstrated that he was knowledgeable about the needs of individual residents and that he had clear lines of accountability regarding the running of the home. He has the qualifications expected of a registered manager and the relevant managerial experience. In order to develop his service the manager, through use of questionnaires, seeks out the views of visiting professionals, residents and their relatives regarding how they perceive the home. This quality assurance, which sought the views of residents was first carried out in December 2003 and was updated in July 2005. Responses to the questionnaires showed a high level of satisfaction felt by residents for the Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 Page 20 standard of care, social activities, comfort of room, and friendliness of staff. This response was echoed by relatives who responded to their questionnaire, and likewise, visiting professionals. The home operates an appropriate system for the recording of financial transactions. All transactions relating to the finances of residents are recorded with, wherever possible, receipts are being retained. The registered manager said that he had in place a system, which allowed for staff to have regular supervision. In discussion this was confirmed by three care staff. Staff felt supported by the system of supervision in place at the home and the induction programme they had received following their recruitment. Responses by the registered manager to the pre-inspection questionnaire show that the safety of residents is ensured by the home having appropriate policies and procedures, which are updated, and the regular safety checking and servicing of appliances. This was further confirmed valid certification regarding the safety of gas and electrical appliances being available at the time of the inspection, together with a letter from Devon Fire and Rescue dated February 2006 stating that fire safety precautions in the home were satisfactory. Records showed that there is regular fire safety training for all staff and there is a schedule, which ensures that fire safety equipment within the home is regularly tested for safety. Whilst not all radiators in bedrooms have been covered, it was seen that in accordance with recommendations made in the last inspection report, risk assessments had been carried out. To further protect residents, radiators had chairs placed in front of them and in keeping with Health and Safety in Care Homes guidance; the manager confirmed that none of the radiators would exceed a temperature of 43 degrees when the system was running at full capacity. Previous inspection reports have recommended that to fully ensure the safety of residents, radiators should be fully covered. In accordance with requirements made at the previous inspection, the registered manager confirmed that risk assessments regarding hot water in sinks in residents’ bedrooms had been carried out and appropriate action taken to safeguard residents. Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP10 OP38 Good Practice Recommendations In order to ensure that resident’s rights to privacy are respected care plans should be kept more securely. You are recommended to cover all radiators Silver Threads DS0000022162.V293387.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Exeter Suites 1 & 7 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 DS0000022162.V293387.R01.S.doc Version 5.2 Page 24 - 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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