Inspection on 18/09/06 for Thamesfield

This inspection was carried out on 18th September 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

Thamesfield 18/09/08

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Thamesfield Thamesfield Nursing Home Wargrave Road Henley-On-Thames Oxon RG9 2LX Lead Inspector Susan Cledwyn-Davies Unannounced Inspection 18th September 2006 10:30 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 Thamesfield DS0000066484.V307438.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. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thamesfield Address Thamesfield Nursing Home Wargrave Road Henley-On-Thames Oxon RG9 2LX 01483 271477 01491 418133 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) Thamesfield Limited Mrs Diana Wendy Eltze Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 25th August 2005 Brief Description of the Service: Thamesfield Nursing Home is situated in Henley on the river. The nursing home is one part of a large house. The remainder of the house and outlying buildings are warden-assisted flats with support. The house is well decorated and furnished. There are large communal rooms and outside gardens, which are shared with the flats. The nursing home has 12 en-suite bedrooms all with a view of the river. The current fees are £1250 - £1400 per week. There are additional charges for hairdressing, chiropody, physiotherapy, incontinence pads, papers and toiletries. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included a preinspection questionnaire from the manager, assessment of all information kept in CSCI and 6 service user questionnaires received prior to the site visit that took place between 10.30am and 4pm on 18th September. The site visit included discussion with the manager and three staff, conversation with 5 service users with lunch in the dining room. Records seen included care plans, catering records, complaints and accident records. Written feedback was also received from the manager after the site visit. The service users questionnaires were all positive about the care given. Any separate comments are included in relevant sections. What the service does well: 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. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 6 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 Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 7 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 and 6 Good. An outcome group judged as ‘Good’ has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. The statement of purpose and service user guide are up to date. All service users are assessed prior to admission. No intermediate care takes place. EVIDENCE: The statement of purpose and service user guide have been amended to note the new manager and new provider. The registration certificate includes the category terminally ill. This category is no longer valid therefore the inspector is arranging for the certificate to be changed. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 8 All service users are assessed prior to admission to the home. Assessments were seen and formed part of the initial care plan. Visits to the home prior take place by relatives or friends and/or service users. One Service user spoke of staff being very welcoming. Intermediate care does not take place in this home. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9 and 10 Good. An outcome group judged as ‘Good’ has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. Care plans are reassessed regularly. Health care is provided regularly. The manager and staff aim to provide a home for life. Medication is safely managed. EVIDENCE: Care plans of three service users were seen. These were comprehensive and included assessments of care needs and risk assessments. There was a previous requirement to include a bathing risk assessment detailing any individual care needed. Care plans were reviewed monthly. All care plans are discussed with service users and relatives as appropriate. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 10 Health care is provided by a local GP who visits weekly. All service users are reassessed at least monthly. Medication administration is by the sister on duty. As part of their induction the nurses go through the home’s administration policy and procedure plus being observed in practice. A brief record is kept of this. There is no reobservation to check practice is according to the home’s procedure, the manager confirmed that this would in future be part of the annual appraisal. The record keeping is good; the exception is that no record is kept of medication brought into the home and when a new bottle of medication is started. This is important so that there is a full audit of all medication in the home in case of problems. The manager advised in writing that a record of medication brought in has been started and that on medication records when a new bottle is started the signature is circled in red. Medication is stored in a locking trolley and in locking cupboards. Medication training has been given. The home aims to provide a home for life. Recently the manager and in collaboration with the GP were supported by the Macmillan nurses to provide best possible care. The manager has just obtained the End of Life care programme training and is arranging study days for all staff. In discussion it was clear that ensuring service users received the best possible care until the end was important to the Manager and staff. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 and 15 Good. An outcome group judged as ‘Good’ has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. A variety of activities are arranged. Relatives and visitors are made welcome. Service users have choice and control. The menus planned are impressive and varied. More work is still needed to ensure consistency of service. EVIDENCE: There are a variety of activities arranged by an activities person. These include exercise groups, games and handicrafts plus entertainment being brought in. There are community contacts also, during the site visit the local WI held a meeting in the house joined by service users as they wish. Service users were positive about the arrangements in their questionnaires. “It is very nice to have an activity Annie who keeps us amused”. Other service users commented that there are sometimes activities they like, but in conversation service users were positive about the activities provided. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 12 Visitors are welcomed, service users confirmed this and also they are always given refreshments nicely presented. Service users have choice and control over their day. Staff in conversation confirmed this. E.g. Service users have flexibility about when they get up in the morning. One service user commented, “ This is really a good home. I have been here for some years and one is bound to find in that time many little things are not always perfect.” The menus showed that there is good choice of food and individual choice is catered for. The diet provided is generally appreciated but there have been problems with the standard of food provided can be variable and not always adhering to the menu. For example on the day of the visit service users were given a different dessert to that chosen on the menu. The constituents were similar but the bananas were not cooked. Looking at the comments book and in discussion with the manager, she was aware of the problem. Most of the time there is no problem. There has been some new staff in the catering team and this has contributed. The senior cook is becoming the catering manager and will be helping to ensure that the standards are maintained plus other staff changes are taking place. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 13 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 and 18 Good. An outcome group judged as ‘Good’ has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. Complaints are responsibly managed and service users have confidence in the manager. There is a positive approach to the protection of vulnerable adults. EVIDENCE: There was a requirement from the previous inspection that the complaint procedure includes recourse to CSCI if necessary and this is now included. The complaints record was seen and clearly showed that action was taken and any complaints resolved. The comments and suggestions book also showed any action taken and the result. Service users confirmed that they had confidence in the Manager sort out any problems if possible. There is a policy and procedure for the protection of vulnerable adults and the preinspection questionnaire confirmed that this had been reviewed in 2005. Care staff confirmed that they had had training in the protection of vulnerable adults and confirmed in discussion that they would report any concerns to the manager. The manager is obtaining shortly a training video to use for all staff as a refresher course. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 14 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 and 26 Excellent. An outcome group judged as ‘Excellent’ has substantial strengths and a sustained track record of delivering good performance and managing improvement. Where areas for improvement emerge the service recognises and manages them well. We would expect to see the essential elements found in an outcome judged as good with further additional strengths. The performance does not have to be perfect to be excellent in an outcome area. The key NMS under this outcome heading are met. The examples are illustrations only and should not be regarded as a tick box. The house and gardens are well maintained. They provide a good environment for service users. Service users are satisfied with the service provided. EVIDENCE: The house was very well presented, being clean and tidy with good decoration and furnishings. Two service users confirmed this in their questionnaires, “the home is fresh and clean always” and conversations and observation confirmed this. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 15 The gardens are extensive and well maintained. There is seating around the garden as well as by the river. There are plenty of parking spaces available. There was a requirement from the previous inspection that the security CCTV be removed from the entrance hall and corridors of the home. This has been done. Each service user has a large bedroom with an ensuite bathroom. These bathrooms are used for baths so hoists are provided. There is one hoist that is transferred to other bathrooms. This hoist has limescale on the seat that would prevent good cleaning. The manager advised following the site visit that the seat had been descaled and cleaned thoroughly. Also that she is discussing with the provider putting hoists in all bathrooms currently without and needed by service users to avoid the manual handling risk of transferring bath seats. Medication is stored on the first floor next door to the sluice. There is a gap in the wall dividing the sluice from the medication store. The manager agreed this is not a good place for the store because of the small risk of infection. She is negotiating with the providers to plan for new storage elsewhere. The communal areas are shared with the flats. There is a grand dining room that is also used for concerts, shows etc. The lounge has a bar area and the bar is open prior to lunch. Service users socialise with other occupiers of the site. The housekeeper and her staff provide the domestic services. There is domestic cover 7 days a week. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 16 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 and 30. Good. An outcome group judged as ‘Good’ has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. Sufficient staff are on duty. Recruitment is ordered and safe. Staff training is encouraged. NVQ training has met the standard. Basic training is given and the manager is ensuring that updating training takes place. Individual staff supervision takes place. EVIDENCE: The staff rota shows sufficient staff and service users confirmed that staff are generally available. Service users noted that sometimes they had to wait for attention. Service users were very positive about the care given; one noted, “ The matron, sisters and carers are all very thoughtful and kind”. There was a previous requirement to ensure that a qualified staff member is on duty and this takes place. Also the requirement asked that there is sufficient staff on duty. There are periods when staffing is short as noted by the wait for attention from service users. The manager will continue to monitor this. The two latest recruitment files were seen. These showed that application forms, references and CRB checks were completed prior to starting work. Staff Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 17 recruitment is safe and orderly. There is a separate record kept for staff working with a work permit to ensure this permit does not lapse. All new staff receive induction training and work as supernumerary for up to a week. Induction training is recorded. Following discussion the manager is ensuring that induction records are more detailed, to ensure staff all work according to the home’s standards. There is a positive approach to NVQ training; of the 8 carers working during the 24 hours five have completed NVQ 2 training. Therefore the standard of 50 as a minimum is met. New staff will be encouraged to complete the course. Training is available. The manager is also aware that updating training needs to be arranged and is purchasing videos to use to refresh staff. A training video in food hygiene has been purchased staff are completing the video and questionnaire. The manager confirmed in writing following the site visit that staff meetings have taken place for housekeeping staff and that a nursing staff meeting is arranged shortly. Carers meetings will also be held. A record of the meetings will be kept and available for staff. This was asked for at the previous inspection. Individual supervision takes place; records and staff discussions confirmed this. Annual appraisals also take place for all staff. Staff also advised that the manager is supportive and helpful especially if there is a problem. Staff also noted that the staff all work well together. This had also been asked for at the previous inspection. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 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, 33, 35 and 38 Good . An outcome group judged as ‘Good’ has more strengths than areas for improvement. There are no significant weaknesses in areas relating to health and safety issues or management. The key NMS under this outcome heading are generally met but there may be some areas of improvement that we are confident the provider can manage. Where areas for improvement emerge the service recognises and manages them well. The manager is experienced and has a care qualification. She is starting management training. Service users were positive about the care given. The manager will be developing the quality assurance systems. Resident monies kept by the manager now have clear records kept. Health and safety systems are in place. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 19 EVIDENCE: The manager has a care qualification and has many years experience of care work. Following her appointment and registration as manager she is taking the registered managers award that includes management training. Service users said that the manager is always helpful and that if they have any complaints she will sort them out. Staff confirmed that she gives clear guidance. Quality assurance is developing. The manager expects to provide further opportunities as she completes the NVQ 4 in management training. At present the strategies to make sure that the home is run in the best interests of the service users include the following. All service users have a care plan which is discussed with the service user and relatives. Service users wishes in terms of choice and daily routine are respected. Social events to which service users and relatives are invited include the Xmas buffet, summer fete and socials. There is a comments/suggestions book in which any comments made are followed up. Residents finance is not generally kept. Some monies are kept in safekeeping for 2 service users. During the visit detailed records were not available. Following the site visit the manager confirmed that receipt books were now obtained to keep detailed records including receipts. The home’s policies were being amended during the visit to include the new provider. Health and safety is taken seriously in the home. The preinspection questionnaire sent to CSCI demonstrated that regular servicing and safety checks take place within the home. There was a requirement from the previous inspection that accident records for the home be kept separately from those of the close care apartments. This is now done. Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 17 X 18 3 4 X X X X X X 4 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 X 3 X 3 X X 3 Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 21 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. Refer to Standard Good Practice Recommendations Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Oxford Office Burner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford, OX4 2SU 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 Thamesfield DS0000066484.V307438.R01.S.doc Version 5.2 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!