Inspection on 14/10/08 for The Thorns

This inspection was carried out on 14th October 2008.

CSCI found this care home to be providing an Good service.

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

The Thorns 10/10/06

The Thorns 13/01/06

The Thorns 19/08/05

The Thorns 27/01/05

The Thorns 22/06/04

The Thorns 29/08/02

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Thorns Coastal Road Hest Bank Lancaster Lancashire LA2 6DW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Plant     Date: 1 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Thorns Coastal Road Hest Bank Lancaster Lancashire LA2 6DW 01524822558 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Denise Audrey Shuttleworth Type of registration: Number of places registered: Morpress Properties care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 15 Date of last inspection Brief description of the care home The Thorns is owned by three family members, operating under the name of Morpress Properties. The home has a registered manager who runs the home, supported by a deputy and senior care staff. The Thorns is situated in Hest Bank village near Lancaster and close to the Lancaster canal. The home provides accommodation for a maximum of fifteen residents of both sexes who are 65 and over. The home is situated at the end of a private driveway and there are some local shops nearby. Accommodation is provided in 11 single and 2 double bedrooms. The double rooms are mostly used as Care Homes for Older People Page 4 of 31 Over 65 15 0 Brief description of the care home singles, unless they are occupied by married couples who want to share a room. All the bedrooms have en suite facilities. The bedrooms differ in size, but most are spacious and residents are able to bring their own posessions into the home and so personalise their bedroom. There is a large lounge, a dining room and a conservatory/entrance porch, with good views down the driveway and over the front garden, which has a pond. The current weekly fees are between £510.00 and £585.00 with additional payments for services such as hairdressing and chiropody. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The visit to the home was unannounced and looked at all of the key national minimum standards, plus the standard relating to staff supervision. At the time of the visit there were 13 people resident at the home. The inspector spoke to the manager, the cook, two care staff and several people living at the home. There was also opportunity for a Care Homes for Older People Page 6 of 31 brief discussion with one of the joint owners of the home, who called in during the visit. Information was also gained from the Annual Quality Assurance Assessment completed by the manager. The Annual Quality Assurance Assessment is a self- assessment that focuses on how well outcomes are being met for people using the service. It also provided some numerical information. CSCI survey forms inviting feedback about The Thorns were received from three members of staff and seven people living at the home. Records were viewed and a tour of the building took place. Time was also spent observing staff and the people living at the home, as they went about the day’s activities. The last key inspection was in October 2006, with a service review in December 2007. The report relating to the service review is held at the CSCI office and would be made available if requested. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 31 The medication arrangements at the Thorns are generally good. However any member of staff who handles medication should have undertaken accredited training and when handwritten records have to be made these should be checked by two staff. This would help to ensure that errors are not made. Qualification training is promoted at the Thorns. There is however a need to ensure that all staff complete basic training and that this is regularly updated. This will help to ensure that staff have the basic skills to do their job well. All care staff should receive regular recorded supervision. This gives opportunity for performance and training issues to be discussed and forms an important part of staff development. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Thorough assessments take place prior to anyone being admitted to the home. This helps to ensure that their needs can be met. Evidence: The manager carries out an initial visit, to gather assessment information, prior to individuals coming into the home. Senior care staff then gather further information, which is used to inform the care plan.The records for three people were viewed. Records showed that good pre admission information is gathered and that relatives are involved in this process. Information includes details of health and social care needs and highlights any areas of risk. This pre admission assessment means that individuals are not admitted to the home if their needs cannot be met. Areas addressed within the assessment include likes and dislikes, leisure activities, Care Homes for Older People Page 11 of 31 Evidence: lifestyle and expressing sexuality, as well as more practical issues such as personal care needs. Areas of risk are identified and risk management plans put in place. Files contain a useful checklist confirming that important information such as; a contract, a copy of the complaints procedure,explanation of the nurse call system and the fire procedure have been provided to the individual. Information within the CSCI surveys completed by people living at the home confirmed that people receive good information prior to moving into the home and that contracts are in place. A group discussion took place with three people living at the Thorns. All agreed that they were happy with their choice of home. The Thorns does not provide intermediate care or short-term intensive rehabilitation. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and health care needs are met and people are treated with dignity and respect, promoting a feeling of well being. Improvements in the arrangements regarding medication would help to reduce the likelihood of errors being made. Evidence: Each person has a written plan of care and three of these were viewed. Each area of need identified has a separate care plan, giving staff guidance regarding how the need is to be met. These individual care plans are clear, meaning that the information is easy for staff to access and then follow. Care plans are being regularly reviewed, with changes made if necessary. It was seen that for one person, who is in poor health and is being cared for in bed, that her care plan had changed to incorporate the skin care she now needs. Although care plans are being regularly reviewed, this review is only recorded if changes have been made. This is a small care home and staff get to know people very well, meaning that any changes are quickly identified and addressed. However the Care Homes for Older People Page 13 of 31 Evidence: manager is advised to record the reviews, even if changes have not been made to the care plan. Risk assessments are in place and these too are being regularly reviewed. Each person has a moving and handling risk assessment, with other risk assessments in place where needed. The day staff keep good daily records giving an overview of how people had spent their time. For one person his care plan identified that he liked to go out for walks and the daily records showed that this was happening. At present night staff make their records on a handover sheet, which is used to pass on information to the day staff when they come on duty in the morning. This recording system was discussed with the manager. It is advised that night staff also record on the daily notes as this will give a 24 hour overview of each person and how they have been. For ease of access these individual records could be kept in one file. Handover notes could still be used, if needed, but could then be destroyed. If all staff contributed to the daily notes, this would build up a comprehensive picture of that person and their life at the home. One person living at the home who completed a CSCI survey stated; This home is exceptional in the care and service that it provides. Especially when ones needs are over and above the usual requirements. Good records are kept of health care visits such as from district nurses or GPs.These make it easy to track the health care input for each person. Files contain a record of weight for each person, meaning that any significant changes in weight can be responded to. On the day of the inspection visit a district nurse was visiting an individual at the home. The district nurse spoke to the inspector and gave excellent feedback regarding her view of the home, stating that the staff are very good, advice is always followed and that the home is always clean. Information within the CSCI surveys completed by those living at the home confirms that people receive the medical support that they need. Once a fortnight Tai Chi sessions are held at the home. These are conducted by an external practitioner, and the inspector was told that these sessions are particularly enjoyed by the men living at the home. Exercise such as this promotes good health as well as a sense of well being. Medication is safely stored in a locked cupboard. The majority of medication is provided in a Nomad cassette system, set up by the pharmacist. The medication Care Homes for Older People Page 14 of 31 Evidence: records for three people were viewed.Records include a photograph of the individual. A record is kept of all medication coming into the home and of any medication returned to the pharmacy. Arrangements for the storage and recording of controlled drugs are also in place. The manager confirmed that she carries out checks regarding the medication procedures at the home. Although the medication procedures at the home are generally good, there are improvements which need to be made. It is advised that staff use the codes printed on the medication sheets, when any medication is not given or is refused. This will help to create consistency within the records. When handwritten records have to be made regarding the medication to be given, then these should be checked and signed by two people. This will help to reduce the chance of errors being made. One member of staff who administers medication has not undertaken accredited training and this should be addressed. The importance of privacy and dignity are addressed during the induction period and also within NVQ (National Vocational Qualification) programmes. Staff were observed speaking to people in a respectful and sensitive manner and knocking on bedroom doors and awaiting a response before entering. All bedrooms are single and have en suite facilities, providing privacy during times of personal care. Information on files includes how the individual expresses their sexuality. This includes preferred clothing, make up and jewellery. People are supported to dress smartly and take pride in their appearance. A hairdresser regularly visits the home to provide a service to those living there and two people have made their own hairdressing arrangements which are supported by staff at the home. Time was spent talking to one lady who explained that she liked to wear jewellery which had been given her by her son and she confirmed that staff helped her to do this. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social contacts and activities are supported. People are supported to make decisions about how they spend their time, promoting autonomy. Nutritious meals are served and mealtimes are a pleasant experience. Evidence: The activities programme was discussed with the manager of the home. Regular activities include a fortnightly Tai Chi session and a monthly visit from a musician/singer, who was performing at the home on the day of the inspection visit. Approximately eight people were enjoying this music session, with a member of staff supporting and encouraging people to become involved. The entertainer provided small percussion instruments for people to use and encouraged audience participation. Part of the session was observed and the people involved appeared to be enjoying this session. Occasional trips out take place, when a bus is hired. An individual spoke of a recent trip to a nearby beauty spot followed by afternoon tea at a café. Another person had mentioned this trip on their CSCI survey, saying that they had enjoyed it. The Care Homes for Older People Page 16 of 31 Evidence: manager explained that some staff who have appropriate car insurance, sometimes take people out for a run in their car. A church minister comes to the home every two weeks to provide communion, with some people from the local community also coming to the home to participate. The manager explained that coffee mornings used to take place, inviting people from the neighbourhood, but that interest in these had waned. It was also confirmed that staff support people to take short walks out of the home. A hairdresser visits the home every week, daily papers are delivered to the home and bingo sessions also take place. During the inspection visit it was noted that staff were spending time talking to and listening to those living at the home, which is a meaningful activity in itself and should be encouraged. Feedback from the CSCI surveys was mixed, with some residents appearing happy with the activities and others feeling that improvements could be made. One person commented; I feel that there is not enough stimulation to keep residents from falling asleep in their chairs. It is important that the provision of activities is kept under review, discussed with those living at the home and improvements made if necessary. Although there were no visitors during the inspection visit, people confirmed that visitors are made welcome. One person who completed a CSCI survey stated; visitors are welcome at all times and there are no petty restrictions. All bedrooms are used as single rooms, with most being spacious, with comfortable seating, providing privacy for anyone who wishes to entertain their visitors away from the main lounge. There is a friendly resident cat, providing comfort and interest to people living at the home.The conservatory/entrance porch provides a good viewpoint, where people can sit and look out for their visitors or look at the attractive front gardens and pond area, which attract wildlife. People are supported to make decisions about their day-to-day lives, such as when to go to bed, when to get up and how to spend their time. Peoples’ views and opinions are valued and autonomy is encouraged. On the day of the inspection visit some people had chosen to spend the morning in their bedroom, reading or watching television, with staff serving mid morning drinks in their bedroom. In the afternoon when the entertainer was performing in the lounge, the few people who did not want to join in were able to sit in the conservatory. On looking around the home it was clear that people are able to bring their own possessions, such as pictures and ornaments, with them and make their bedroom more homely and familiar. One person brought his piano with him and although he no Care Homes for Older People Page 17 of 31 Evidence: longer plays, the piano has remained. Individuals are supported to manage their financial affairs for as long as they are able. For some people a family member takes on this responsibility. The cook explained the arrangements for meals at the home. People are able to choose what they want for breakfast and most people choose to have breakfast served in their bedroom. The main meal is at lunch time and is prepared by the cook. Care staff usually prepare tea or the cook may make something such as soup, in advance. Files contain information regarding food preferences and the cook explained that as this is a small home, she knows what people like. People are offered an alternative if they dont want to have the main lunch time meal.The manager or the deputy usually do the food shopping and will ask those living at the home if they have any special requests or preferences to add to the shopping list. Different nutritional needs are catered for. At present one person has to have their food liquidised and another person has to monitor her diet as she has diabetes. A record is kept of all meals provided. The inspector joined the residents for lunch, which was tasty and nicely presented. The dining room provides a pleasant place to eat and care is taken to ensure that the tables are nicely set, with proper linen, napkins, cruet sets and table decorations. Feedback from the CSCI surveys was mainly very favourable, although one person did say that the lunch time meals can be repetitive. This appears to be a minority view. The people spoken to during the visit stated that they were happy with the food at the home and information from one of the surveys completed by staff indicated that the food at the home is very good. The kitchen is situated in the centre of the home, with the door kept open, allowing people to see what is going on. People are able to stop and have a chat as they pass, giving a sense of involvement and promoting a family type atmosphere. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to raise any concerns. Good practice and staff training promote the protection of those living at the home. Evidence: Each persons file contains a checklist confirming that important information has been given to them. This includes a copy of the homes formal complaints procedure. The manager confirmed that no complaints have been received since the last key inspection. The people living at the home who completed CSCI surveys all confirmed that they know who to speak to if they are unhappy and how to make a complaint if this was needed. Surveys completed by staff indicated that staff know what to do if a concern is brought to their attention. This is a small home, where the manager and deputy work alongside the care staff. Any problems tend to be dealt with as they arise and those living at the home are encouraged to air their views as part of day to day life at the home. The family type atmosphere encourages opinions to be shared and regular discussions take place. There are also occasional residents meetings and an individual living at the home confirmed that items for the agenda are welcomed. There are policies and procedures in place regarding abuse and protection. Nearly all of the care staff have achieved an NVQ (National Vocational Qualification). Abuse and Care Homes for Older People Page 19 of 31 Evidence: protection are one of the mandatory units within NVQ training and therefore staff have a good understanding of the issues involved and the vulnerability of older people in care homes. There are good arrangements in place for the safekeeping of personal monies, with separate account sheets being kept and the cash held being checked regularly. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Thorns provides excellent accommodation, is well maintained and clean, with very good quality furnishings and fittings, providing a comfortable and homely place to live. Evidence: The home has a private driveway, with parking at the front and rear of the building. The gardens at the front of the home are well maintained, with a pond and water features. There is a post office and a few other shops within close walking distance. The Lancaster canal runs along the back of the home and there is a path directly onto the towpath. This path is steep, although some people living at the home are able to take short walks here, with staff support, when the weather is fine. The home has a large lounge, a dining room and a conservatory/ entrance hall with seating. These communal rooms provide people with a choice of where to spend their time. The conservatory has good views down the drive and over the front garden and pond, providing a pleasant place to sit.The kitchen is situated off the main hallway, meaning that people are able to look in as they pass and chat to the cook. All the bedrooms have en suite facilities. Most have a toilet, washbasin and bath or shower, with three bedrooms just having a toilet and washbasin. There is a large Care Homes for Older People Page 21 of 31 Evidence: bathroom with assisted bath on the first floor and a toilet on the ground floor close to the lounge. The bedrooms are different sizes but in the main are spacious. The furniture and furnishings within the home are of a very good quality and everywhere is well maintained. Since the last key inspection two of the en suite areas have been refurbished with disabled access showers installed, the garden paths improved to give better access and radiator covers have been fitted throughout the home. As well as general redecoration within the home, one of the bedrooms was painted a different colour at the request of the occupant.There is just one radiator cover to refit, following the refurbishment of one of the en suite showers. The manager confirmed that this will be attended to promptly. One of the joint owners of the home explained further plans for improvement, which include the redecoration of the outside of the home. A part time gardener is employed, who also carries out some maintenance repairs at the home. There appears to be a well organised system in place for ensuring that any jobs are completed and the maintenance records were viewed. Information within the AQAA (Annual Quality Assurance Assessment) completed by the manager confirmed that all equipment is regularly maintained. On the day of this visit it was noted that fresh flowers are placed around the home and everywhere looked very clean. A cleaner works at the home each Saturday, with the rest of the cleaning duties being carried out by care staff. A cleaning schedule is in place to ensure that each bedroom is regularly cleaned. Good practices are in place regarding infection control and some staff have had training in this area. Soap and paper towels were available in the toilet and a district nurse who was visiting during the inspection and often comes into the home, remarked that the home always appears clean and fresh.The laundry is sited at the back of the home,with a member of staff allocated to this task each day. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team are generally well trained, qualified and experienced, meaning that the people living at the home are supported by competent staff. Good recruitment procedures are in place, helping to ensure that only suitable staff are employed. Evidence: On the day of the inspection visit there were three care staff on duty plus the manager of the home and one of the cooks. The manager explained that there are always three care staff on duty in the day time and during the week the manager and the deputy are also on duty at the home. The deputy manager was on leave on the day of the inspection. In the evenings there are two care staff on duty, with a member of staff on waking duty throughout the night plus a member of staff on call and available in the case of any emergency. The staff rotas viewed showed that these staffing levels are maintained. A part time gardener and a part time cleaner are also employed. The staff team has remained stable, with very few changes, meaning that the people living at the home know the people who are caring for them. A handover sheet is used to pass information between the day staff and the night staff. This also details staff responsibilities for that day, such as who is responsible for medication, drinks, laundry etc. It may be useful to include activities on this handover sheet, detailing who is responsible for organising the activities for that afternoon. Care Homes for Older People Page 23 of 31 Evidence: Three members of staff completed CSCI surveys, with one commenting; staff work well together, in a team and individually. With regard to the surveys completed by people living at the home, when asked Are staff available when you need them? one person responded, Yes - at all times and in the night as well. There are 11 care staff at the home, excluding the manager. Nine have achieved NVQ (National Vocational Qualification) level 2 or above. The deputy manager is working toward gaining the Registered Managers Award and several of the care staff have embarked on higher level NVQ programmes at levels 3 and 4. The high percentage of qualified staff at the home exceeds the recommended 50 and is to be commended. Both the cooks working at the home have gained NVQ level 2 appropriate to their work role. It is clear that staff working at this home have excellent opportunities to pursue qualification training, meaning that people living at the home are supported by a skilled staff team. The recruitment records for a recently appointed member of staff were viewed. Records include an application form, a record of the interview, two references, a Criminal Records Bureau disclosure and a check against the list of people who have been deemed unsuitable to work with vulnerable people. The manager explained how she considered all the information contained within these records before making a decision to appoint the person to the staff team. Although the majority of staff have completed NVQ programmes and some aspects of health and safety are included in the NVQ mandatory units, there are still some gaps in the basic training that all staff should receive. Records show that not all staff have undertaken food hygiene and infection control training. The current records make it difficult to see when refresher training such as moving and handling is due to be done. One member of staff administers medication but has not received accredited training in this area. An up to date training matrix for the team would help to identify any gaps and when any update training is required. New staff spend one day with a senior member of staff, going through a general orientation of the home and the fire procedures. They then work alongside an experienced member of the team until they are deemed competent to work alone. A member of staff in post for 18 months confirmed this shadowing arrangement. Basic training should be built into the induction programme for new staff and include moving and handling, food hygiene, fire safety, infection control and first aid, plus any other training that the manager feels is necessary. This would ensure that the induction and training programme at the home meets with nationally recognised standards. Care Homes for Older People Page 24 of 31 Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home which is well managed. The health and safety of staff and people living at the home is promoted. Evidence: The home is owned by Morpress Properties, which is a family owned business.The manager has worked at the home for many years, has gained the Registered Managers Award and is registered with the CSCI. The manager is also a qualified NVQ assessor and confirmed that she is able to attend training courses to keep her up to date in the field of social care. The deputy manager is currently undertaking the Registered Managers Award. The deputy and senior care staff at the home carry out certain management duties and support the manager in her role. Comments from CSCI surveys completed by staff included; Staff feel confident with the management, and The staff feel comfortable telling any issues to the manager, any problems are dealt with quickly and appropriately. Care Homes for Older People Page 26 of 31 Evidence: During the inspection a discussion was held with two staff who said that both the manager and deputy are approachable, they will listen to staff and are open to ideas and suggestions. One person living at the home who completed a CSCI survey described the home as; A first class place to be in all respects. There are quality monitoring systems in place at The Thorns. The manager has recently distributed questionnaires to people living at the home and their relatives. Some of the responses were seen and these were generally favourable. The questionnaire used was quite detailed and the manager is considering how best to simplify the surveys used and encourage a high level of response. A discussion took place regarding the possible merits of designing questionnaires which just focus on one or two areas of service provision and then covering different areas the next time. The home achieved the Investors in People Award in 2003, which is a national quality standard which sets a level of good practise for improving an organisations performance, with effective management being a key factor. This award has not been reviewed or renewed as the owners of the home are looking at different external accreditation systems and considering their value, in terms of the service provided at The Thorns. One of the joint owners has regular contact with the home, often calling in to chat with the residents and staff and to see how things are. He also has monthly meetings with the manager of the home and records of these were seen. The manager and deputy manager work alongside the care staff at the home. This means that they are able to guide staff and show them how they want them to work. The three staff who completed CSCI surveys all responded that the manager regularly meets with them to give support and discuss their work. This support is carried out informally as part of day to day working. The atmosphere at the home is warm and informal with staff spending time talking to and listening to the people living there. There are also occasional residents meetings and an individual living at the home confirmed that items for the agenda are welcomed.Some people prefer to share their views and ideas on an individual basis as part of day-to-day life at the home. This individual approach also means that people with hearing difficulties are not excluded or disadvantaged. Staff confirmed that occasional staff meetings do take place, however there are Care Homes for Older People Page 27 of 31 Evidence: regular informal meetings when staff sit together and discuss how things are going and what improvements could be made. There are good arrangements in place for looking after personal money if this is needed. Small amounts of spending money can be held on behalf of people living at the home. Individual account sheets showing income, expenditure and the balance of money held, were seen. All money is securely kept in a safe and the accounts are regularly checked. Only the manager and deputy have access to the safe, providing extra safeguards. All staff have an annual appraisal with the manager or the deputy and some of these records were viewed. The form used is very good as it includes a section for the member of staff to consider and then rate their own work performance. This encourages staff to think about how they work, the things they are good at and the things they may need help or training with. The two cooks also have an annual appraisal. Supervision records were seen, showing that these have tailed off recently. All care staff should receive regular, recorded supervision at least six times a year. People newly admitted to the home have the fire procedure and the nurse call bell system explained to them. Some health and safety training takes place, with certain elements being addressed within NVQ programmes. Shortfalls in this basic training have been addressed within the staffing section of this report. Records were seen regarding checks to fire equipment, fire alarm testing, lift servicing and gas safety inspection. Water temperatures are thermostatically controlled, preventing the water from becoming dangerously hot.The part time gardener carries out some maintenance jobs and records of these were seen. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 All handwritten medication records should be checked and signed by two staff. This will help to reduce the likelihood of errors being made. Staff who administer medication should have undertaken accredited training. This will help to ensure that they are competent to carry out this task All care staff should undertake a core training programme, with a focus on health and safety topics.This should form part of the induction period and be regularly updated. This will help to ensure that all staff are working to a consistent standard. All care staff should receive formal supervision at least six times a year. This will provide opportunity to discuss any performance or training issues. 2 9 3 30 4 36 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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