Inspection on 06/07/05 for Theobald House

This inspection was carried out on 6th July 2005.

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

Theobald House 28/02/07

Theobald House 14/11/05

Theobald House 30/09/04

Theobald House 11/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Theobald House 75 Theobald Street Borehamwood Hertfordshire WD6 4SL Lead Inspector Jan Sheppard Unannounced 6 July 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Theobald House Address 75 Theobald Street Borehamwood Hertfordshire WD6 4SL 0208 953 1798 0208 953 0986 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Peaceknoll Limited Ms Maria Philips Care Home 13 Category(ies) of OP Old Age - 13 registration, with number of places Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 30 September 2004 Brief Description of the Service: Theobald House is a large detached two storey property which has been converted for the use as a care home. The original house built in the 1930s has been extended to provided a total of twelve bedrooms, eleven single and one double. The ground floor comprises an entrance lobby and hall, a dining room, a lounge, a smaller lounge library room, 5 single bedrooms, the kitchen, the laundry room, a staff room, a store room and an assisted bathroom and toilets. Seven bedrooms, 2 bathrooms ( one assisted ) and the office are located on the first floor. There is a very pleasant and easily accessible garden to the rear of the property, which includes a sheltered patio. To the front there is ample off street parking as well as a garage. The house is within walking distance of the local shopping facilities, restaurants and pubs and there is a local bus service and the railway station is close by. The home, which is owned by Peaceknoll Ltd., is managed by its owner manager and was first registered under the 1984 Registered Homes Act, in March 1985. It provides comfortable homely accommodation and care for its elderly residents in a safe and secure environment. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the first of this inspection year and took place over one day. Time was spent talking with all the residents, their visitors and visiting professionals. All the staff who were on duty during this day were also spoken with. Discussions were held with the manager and time was spent in the office looking at care plans records and staff files. The residents were very welcoming and without exception they all spoke very positively about the care that they receive and about the manner in which that care is delivered to them. Four residents admitted to the home since the last inspection all spoke positively about the way that their admission had been arranged and said that this had helped them settle quickly and that they were happy in the home. 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. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 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 standard(s) 1,2,3,4,and 5 Information available to prospective service users is comprehensive and informative enabling a realistic decision about admission to be made. The atmosphere in the home is relaxed offering a welcoming environment to prospective service users. EVIDENCE: The manager personally assesses all prospective residents referred to the home either in their own homes or in a hospital or other setting this to ensure that their needs could be fully met and that they would be compatible with the existing group of residents at Theobald House. All prospective service users and their families have the opportunity to visit the home and all do so prior to any final decision about admission being made. An information file containing the need to know details about the home is available this includes the Service Users Guide, the Statement of Terms and Conditions, information about fees and other contractual obligations, the Complaints procedure and copies of previous Inspection Reports. The records for the most recently admitted residents evidenced that this procedure had been carried out appropriately and this was confirmed by the residents who spoke with the inspector. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 Page 8 One, who had only been resident for a few days told the inspector that whilst if she could choose she would rather still be living in her own home she realised that this was no longer safely possible for her and that her introduction and welcome at Theobold House had been sensitively and smoothly managed; she concluded “you can put a big tick by my name” Another relative of a recently admitted resident told the inspector of her experience when she had made an initial unplanned evening visit to the home and the kindly way in which the staff showed her all around the home and then enabled her to speak privately with the existing group of residents about their experiences of living in the home. “It was all done very professionally and I realised at once that that the atmosphere in this home was markedly different from the others that I had visited“ she said. On the day of this unannounced inspection the home had two vacancies as well as a number of prospective applicants whose possible admission to the home was being considered. All new residents are subject to a trial period, usually six weeks, after which a review is held to ensure that their care needs are being met by the home and to independently ascertain their views and wishes. The attendance of families and representatives along with medical and social work reports where appropriate are encouraged at these review meetings. All residents have a contract a statement of terms and conditions that gives details of their room, the fees payable, notice periods, the care and services that they will receive and the terms and conditions of their occupancy including their rights and obligations in the event of any breach of contract. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 and 11. Personal care and assistance offered to service users is of a high standard thus meeting their individual needs whilst maintaining dignity and respect. Care staff are unobtrusive and sensitive in their approach. Care plans are comprehensive and reviewed regularly ensuring that changes to health and social care needs are recognised and met. EVIDENCE: The care plans examined were found to be comprehensive and to have been regularly reviewed. Over the past three years the format of these plans has been simplified so that they are easily accessible and the improvement in their quality and in the detail as to how care should be delivered to best meet the residents needs and accommodate their wishes is noticeable. Although there was space to do so it could not be seen that care plans had been signed by all the service users (or their relatives) even though staff confirmed that residents were always involved with these review meeting. The inspector discussed with the manager ways that it could be evidenced that the resident had participated in their review, where they had capacity, even if they could not formally sign their plan. The fact that not all of the reviews had been signed or dated by the carer undertaking the review was also discussed. The manager discussed the possibility of the care plans being kept in the residents rooms as a way of helping them to have better ownership of them. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 Page 10 The home maintains good working relationships with the various specialist health professionals. The records kept of any District Nurse visits to the home are kept alongside the homes own care planning documents. Theobold House benefits from the services of a retained Doctor who holds regular surgeries in the home as well as visiting when ever requested. Various other care professionals also visit the home on a regular basis including the optician, dentist, mental health community nurses continence advisor and the chiropodist but the manager explained that if a resident was well enough and wished to do so, staff would always take them into the town to visit their surgeries or shops. One recent visit to the opticians revealed that a cataract was present and the resident is now on the hospital list for its removal. The chiropodist who was visiting on the day of this inspection spoke positively about the care that she observed and about the professional manner in which she was accepted into the home. Individual care practice observed was commendable, staff were seen to give minimal assistance when lunch was served and then to with draw to enable residents to enjoy a peaceful unhurried lunch at their own pace only discretely intervening with more active help if required. The dignity and independence of the resident was upheld at all times. The home continues to use the MDS, monitored dosage system for medication. This is supplied by a local pharmacist who visits regularly to audit the system. The MAR records examined were found to be well kept and accurately recorded and the dates of the managers management checks of the accuracy of these records could be evidenced. Since the last inspection two residents have died in the home, their care needs being met by the homes staff and the doctor and nurses visits. In both cases their relatives were accommodated in the home during this time, (one family for a week) so that they could be alongside their relative and assist with their care until the end. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 For social activities and for their daily life routines the home tries to accommodate each residents individual preferences, feedback and suggestions. This promotes autonomy and choice. Visitors are welcome and the home also encourages integration with the local community in accordance with the residents preferences. The home provides good menu choices with home cooking of fresh meat and organic vegetables that are freshly purchased several times a week. EVIDENCE: Without exception all the residents were very complimentary about the meals their taste quantity and with the manner in which they were served. The recently admitted residents were particularly complimentary about the food and the choices afforded them one compared the standard at Theobolds House very favourably to what he had received in his previous home. Risk assessments had been carried out for all the residents concerning their serving preferences for soft boiled eggs. Breakfasts are served in residents rooms if they wish and it was noted that on the day of this inspection one resident who was watching cricket in his room choose not to join the other residents for lunch in the dining room but to remain in his room so that his appreciation of the cricket could be uninterrupted. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 Page 12 The home has an open house visiting policy and several visitors were seen during this inspection. All the present group of residents have family or friends who can visit or at least keep in touch via phone calls letters and emails. The recent acquisition of a portable phone enables residents who do not have their own landline to be able to take and make calls in the privacy of their own rooms. One recently admitted resident explained to the inspector how the manager had, using the net and a solicitor, enabled him to make contact with his niece his only relative now living in the USA with whom he had lost contact some years ago. He said how thrilled he was to be given a printout of his first dictated email to her and her reply to him. The manager explained that this gentleman could manage the stairs and so could access the office where the computer was kept. Another resident, who could not climb the stairs, had expressed an interest in emails and wondered how they work so the manager intends to borrow a laptop machine which can be operated in the lounge so that more of the residents can participate. The home has a weekly activity programme which the manager explained has recently been changed to be more appropriate for the summer months, (this to include a number of outings to local places of interest), as well as to include a new programmes of activities designed to meet the individual needs and wishes of each new resident. The inspector was asked by two new residents (93 and 96 years old) to join them in completing their daily crossword, another new resident told of his daily garden walking programme arranged to assist him with his weight loss programme, whilst another commented about the afternoon tea dance that staff arrange in the lounge. Staff commented that many of the activities occur spontaneously especially in the mid afternoons before tea and cakes are served and the inspector witnessed this spontaneity. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 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 standard(s) 16,17 and 18 The home has a through complaints policy and procedure. There have been no complaints since the last inspection. The home has policies and procedures concerning Adult Abuse and Whistle Blowing, which ensure that the residents are protected from abuse, neglect and self-harm. EVIDENCE: A copy of the homes complaints procedure is given to all prospective and new residents and their representatives. Residents spoken with whilst having some awareness of this procedure said that if they had any problems they would speak first with the homes manager whom they felt sure would sort things out. A number of complimentary letters received by the home since the last inspection were shown to the inspector. Staff confirmed that they had received training on adult abuse and whistle blowing but no staff spoken with had any experience of the workings of these procedures as there has never been any such investigations in the home. However staff appeared to have a good awareness of the varied ways in which vulnerable residents may be at risk and the inspector whilst observing their delivery of care noted their awareness of this. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 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 standard(s) 19,20,21,22,23,24,25 and 26 The home and its surroundings offer a pleasant, comfortable and safe environment for its residents. It provides adequate space and a homely environment in which to meet their needs. The home is clean and well maintained with a well established maintenance routine. EVIDENCE: The residents bedrooms which are all currently occupied as single rooms are well personalised with photos, ornaments and small items of furniture and have a homely individual lived in feel to them. Specialist furnishings and mobility equipment is provided to meet particular needs and to maximise independence. The home, which is very well maintained, was found on the day of this unannounced inspection to be very clean and tidy with no unpleasant odours. It is surrounded by well stocked and immaculately kept gardens to which residents has free and safe access. Several residents told the inspector how they enjoyed sitting out on the patio amongst the fragrant flowers whilst others spoke of their daily walk around the perimeter path and the staff assistance that they have with this. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 Page 15 The home has an adequate number of toilets and bathrooms including two assisted baths, one on each floor, that fully meet the needs of the residents. On the ground floor the home has several large bedrooms, which are fully wheelchair accessible. As the home has no lift only ambulant residents can be accommodated on the first floor. The home is very well appointed and maintained to a very high standard. Since the last inspection a number of repair maintenance and refurbishment works have been carried out including the redecoration of several of the bedrooms where the resident was able to choose colours and fabrics and new windows fitted in the lounge library room. Two small areas of repair in the kitchen to the seal around the main sink and to the chipped area of formica on a work surface are required. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30. The home is run by a very dedicated and well-established staff team many who have worked at the home for many years. The staff are appropriately trained to meet the needs of the service users and undertake training on an ongoing basis. The home maintains an adequate staffing level to meet the current needs of its residents. All the staff have job descriptions and clearly identified roles and responsibilities within the home. EVIDENCE: All the staff who were on duty spoke with the inspector they clearly work as a very closely knit team and they were all enthusiastic about their work and appeared to take great pride in the service offered by the home staff said that being a small home they are easily able to access help and supervision both on a formal and informal basis whenever this is needed. The manager is actively involved with all aspects of the management of the home on a daily basis. All the staff spoke very positively about the training opportunities that they are offered and the help that the manager and senior carers give them with their studies. The home, which already has more than the 50 NVQ level 2 qualified staff, now has many of these staff working towards NVQ level 3. They Home has done particularly well to achieve this standard so soon considering that none of the staff had previous experience of studying and several were helped initially by attending Access to Learning courses. The home is fully staffed and has not needed to recruit any new staff since the last inspection. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 Page 17 The manager demonstrated how the homes recruitment procedure is carried out, (recently returned CRB checks were examined), and she commented on the number of prospective staff who approach the home each week, seeking employment even though no advertisements have been made. All staff have had an individual training needs profile prepared and their course attendance and achievements form part of their annual appraisal. The records demonstrated that training in the core subjects of moving and handling, first aid, health and safety, food hygiene and infection control is maintained up to date and that all staff have attended training on Adult Abuse and Whistle Blowing. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35 and 38. The home is well run by its owner manager who is a competent and experienced manager working with this client group. She leads a stable and dedicated staff group who work well together as a team and they promote the best interests of the residents at all times. Health and Safety issues are given priority by the staff and this provides a warm and caring environment where the service users seemed relaxed and happy. EVIDENCE: The manager communicated a clear sense of leadership within the home and promotes a sense of belonging to its service users. Pride and dedication is taken with every aspect. All the residents and relatives spoke well of her openness and approach to their care; “nothing is too much trouble I can always speak with her about anything I need, she seems so interested in us“ were comments made to the inspector. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 Page 19 Staff meetings are prearranged and appropriately recorded and evidenced. Staff participate well with the discussions and these discussions often concern quality improvement areas with in the home. It is recommended that these records are kept in better detail and that records are made of both formally planned and informal impromptu supervision discussions which often spontaneously occur in this small setting, so as to fully evidence all this activity. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x 3 x x x x 2 Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 19 Regulation 23 (2) (b) 13 (4) (a) Timescale for action It is a requirement that works of by 31st repair to the seal around the August.200 kitchen sink and to the chipped 5 work surface are carried out. A risk assessment must be by 31st completed for the heated towel August rail in the first floor assisted 2005 bathroom. Requirement 2. 38 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. Refer to Standard 7 Good Practice Recommendations It is recommended that staff always sign and date the documentation when undertaking care plan reviews and that evidence that residents have been involved with their reviews is also recorded. Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ 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 Theobald House I52 s19593 theobald house v237064 stage 4.doc Version 1.40 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. 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