Inspection on 15/06/06 for Thingwall Hall Nursing Home

This inspection was carried out on 15th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Thingwall Hall Nursing Home 08/03/06

Thingwall Hall Nursing Home 26/10/05

Thingwall Hall Nursing Home 15/11/04

Thingwall Hall Nursing Home 19/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Thingwall Hall Nursing Home Thingwall Hall Drive Broadgreen Liverpool Merseyside L14 7NZ Lead Inspector Ms Lorraine Farrar Unannounced Inspection 15 & 16 th June 2006 11:00 Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 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 Thingwall Hall Nursing Home DS0000005473.V293193.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 Adults 18-65. 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. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thingwall Hall Nursing Home Address Thingwall Hall Drive Broadgreen Liverpool Merseyside L14 7NZ 0151 228 4439 0151 254 1951 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) Brothers of Charity Mr Steven Wright Care Home 40 Category(ies) of Learning disability (40) registration, with number of places Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 40 LD Maximum no registered 40, of which up to a maximum of 26 PC (Personal Care) and up to a maximum of 14 N (Nursing) 8th March 2006 Date of last inspection Brief Description of the Service: Thingwall Hall is owned and run by a voluntary organisation called The Brothers of Charity. The service is based in the grounds of Thingwall Hall and provides support and accommodation for adults with learning disabilities. The home provides accommodation over six separate bungalows or flats, some of which are home to 6 people and others home to one person. These living areas share the site with a garden centre and shop, a resource centre, swimming pool and main administration house. There are also other houses in the grounds, which provide support to people with a learning disability. Each living area has its own staff team and budgets and is run to some extent as a separate home. The houses share large landscaped gardens and are near to local shops, transport and facilities. Staff are available within the home 24 hours a day with 2 bungalows providing support from nursing staff. There is also an activity department who provide support to service users on and off site and in small groups as well as on a 1-1 basis. Fees for living at the home are as follows: 1 –4 Willow Close £878 per week Manor View £1088 per week Woodlands View £1014 per week Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information for this inspection was gathered in a number of different ways. This included an unannounced site visit where time was spent reading records and looking at the building. ‘Case tracking’ was used as part of the visit. This involves looking at the support a person gets from the home including their care plans, medication, money and bedroom, time was spent meeting and talking with the service user and with staff about how they meet the persons needs. Case tracking was used to look at life in the home for six of the people living there. Discussion also took place with visiting relatives, other service users, the manager, deputy manager, area director and staff employed to support service users with activities. Any information the Commission for Social Care Inspection (CSCI) has received since the last inspection about the home is also taken into account. This includes the results of comment cards sent out to service users, professionals involved with the people living in the home and relatives. In total, 3 service user comment cards, 3 relative comment cards and 2 professional comment cards were returned. The home contributed information to the inspection by completing a pre-inspection questionnaire. What the service does well: The organisation provides good, easy to understand information to service users. The use of pictures and wherever possible, photographs of the actual person, activity or place are used. This theme is used in information to new and existing service users about the home, minutes of service user meetings and advertisements for activities, amongst other things. Thorough assessments are carried out for people who live in, or want to live in the home, this helps to make sure the home is a suitable place for them to live and that it can meet their needs and choices. The majority of care plans in the home contain a lot of information about the person, how they communicate, the support they need and their choices. During the day service users have access to at least one leisure or occupational activity. Service users bedrooms and most lounges in the home are decorated to a good individual standard. Staff provide support to service users in personalising their room in accordance with their needs and choices. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 6 The home has good recruitment polices in place and offers staff a variety of training to meet service users needs. Staff a have a good understanding of service users, have built relationships with them and are motivated to attend training events to increase their knowledge and provide further opportunities for service users. 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. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The organisation provides service users with easy to understand information about the home and how it is run. New and existing service users have their needs and choices regularly assessed to make sure that the service can meet these. EVIDENCE: The home has a service user guide and statement of purpose, which provide service users and their relatives with information about the home and how it is run. These documents provide easy to understand information and good practice was seen in that they use pictures and where possible photographs so that people can easily relate to and understand the subjects. Copies of these have been given to all service users and were available on living areas. Records were looked at for one new service user and these showed that before the person moved into the home an assessment of the person’s needs had been carried out. All care files looked at also had an up to date assessment carried out by the persons Social Worker. These assessments help the home to make sure they can meet a persons needs before they move in and can continue to do so whilst they are living there. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The majority of service users have care plans in place, which provide information to staff about how to effectively support them, however these are not always updated to reflect the persons changing needs. The home works well in supporting service users to participate in decision making and minimising risks to their well being. EVIDENCE: Individual care files are in place for each service user. These include an Essential Lifestyle Plan (ELP) and a private plan. Areas covered include, the person’s likes and dislikes, preferred routines, how they communicate and the support staff need to provide them with. The information provided is detailed and provides staff with a good overview of the person’s support needs and their choices. Generally the plans are clear, well written and reviewed on a monthly basis to make sure the person’s needs are still being met. On most living areas care plans had been altered as the persons needs and choices changed. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 10 However, on one living area providing nursing support, changes in the person’s behaviour had not been recorded. One service user had recently moved form one bungalow to another, their care plan was not available and staff thought it might have been left at the previous Bungalow. The Manager needs to ensure all care plans are up to date and available at all times. A lack of access to an up to date care plan may lead to staff not providing appropriate support for the service user. It was also noted on some living areas that information about the person was stored in different places, with health plans, monthly de-briefs and ELP’s stored separately. Documents on each living areas are used differently, and this was causing some difficulty for a member of staff who had moved from one living area to another and could not easily find the information she required. Relatives stated in their comment cards that they are involved in planning the service users care and records showed that they are involved in care planning and in general discussions with staff. Service users views are recorded either through their direct participation or through the observations and experiences of people who know them well. Following a recent complaint about lack of regular involvement from one relative the management team offered to meet with the relative and resolve their concerns. Staff spoken with had a good understanding of service users needs and choices and were able to give examples of the way in which the service user communicates these. Staff were seen to discuss with service users what they wanted to do that day and also to respond positively to a service users nonverbal request for a drink. Information about local advocacy groups is available in the service user guide and the home runs a service user forum where service users can voice their opinions about the home and guest speakers are invited at their request. The organisation acts as corporate appointee for most service users in managing their benefit money. Although financial records checked on the living areas were in order there are no financial assessments and plans in place for service users. The manager must provide a financial plan for each person, this must include an assessment of whether they can manage their own benefits, look at alternatives to the organisation acting as appointee and state the benefits each person is entitled to and how this is spent. This will ensure that wherever possible service users or their representatives are supported to manage their own finances and there are clear records of all income and expenditure. The home provides a lot of information to service users in an easy to understand format, this includes some policies and procedures such as fire and complaints. Posters advertising outings contained easy to read language and photographs or pictures. The service user forum discusses a variety of topics Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 11 from activities to inspections and service users can and do raise issues for discussion or review. Minutes of a service user meeting held on 4 Willow Close again covered a variety of subjects and were provided in an easy to understand format. The organisation have recently introduced a newsletter, this is easy to understand and provides a variety of information on the organisation, local colleges, activities and an advertisement for a local voluntary job. Written risk assessments are in place for each service user, these identify individual risks to the person and give clear guidelines about how to minimise them. They are regularly updated as the persons needs and choices change. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, & 17 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users are offered a variety of planned activities, however further development is needed in the activities available to service users at weekends and evenings. Daily routines in the home are flexible based upon the person’s needs and choices. Service users are supported by staff to maintain relationships and contact with their family. Meals are planned around service users choices, however further development is needed in supporting service users to be involved in household tasks and simple meal preparation. EVIDENCE: Staff are employed by the organisation specifically to support service users with activities. These staff are based on site and have 3 rooms and an office within, a resource centre for adults with a learning disability. Two members of activity staff were spoken with and they explained that on site rooms are used for films, sensory equipment and art, they also have access to a large hall which is used for bigger ‘one off’ activities such as a recent Nigerian Culture Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 13 afternoon arranged by the local Pentecostal church. Activity staff described their budget for supporting people with activities as “good” and explained that every service user has the opportunity to take part in an activity for at least a couple of hours once a day. The newsletter advertised an open day at a local college for service users who wish to access courses and a voluntary job in the on site farm shop. Some service users work in the on site garden centre. One service user explained, he used to work in the garden centre but now tends the plants in his garden, “I look after all plants, water them, I really enjoy”. Another service user explained she had attended some further education classes and really enjoyed them. Individual activity plans have been drawn up for each person based upon their likes and dislikes and involving people who know them well. Whilst these were being followed during the site visit in that service users were supported with activities in the morning or afternoon there was less evidence that they are followed by staff in the living areas. Several of these plans stated that at lunchtime service users would be supported to be involved in household tasks and preparing meals, however this was not observed to occur during the site visit. The manager should look at ways of involving service users more in everyday household tasks, this would provide service users with the opportunity to become more involved in the running of their home and develop their skills in this area. One service user had been out with a member of activity staff and decided she wanted to return home, good practice was seen in that the member of staff then spent the time with her in her room supporting her with the things she wanted to do. Some of the living areas have shared transport and this enables staff to support service users to get out and about more. However staff on one area explained they had recently lost their transport and felt this was impacting on the opportunities for people to get out and about. A service user when asked what things there were to do replied “not a lot”. Whilst staff on another area explained that they would like to increase the activities and leisure opportunities they offer to service users at weekends and evenings. Activities at home include, using the garden, watching TV and listening to music. One service users plan identified he liked sitting in the garden, music and motorbike videos and all these things were seen to be in place for him. Most service users were seen to go out during the site visit either with activity or house staff and records showed a variety of activities offered. For example in the three weeks prior to the site visit one service user had been supported to, go on three day trips, use the sensory room, play bingo, attend art and music workshops, go to the sports centre and do a sponsored walk. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 14 Service users are supported to go on holidays to suit their choices and needs, one service user had recently been for a day trip with staff to view and book his holiday accommodation. Relatives who completed a comment card all said that they can visit the home at any time and that they are made welcome and two relatives spoken with said that they are involved in the persons care and made welcome. The home supports service users to maintain family contacts and records showed two service users have staff support to visit their family. One relative commented “I find the staff very friendly, my relative is well and happy in this homely atmosphere. Staff take the residents for outings and holidays. (my relative) and two members of staff invited me to join them for lunch at a pub. I feel a lot of planning went into this enjoyable event.” The home has a policy in place for supporting service users to maintain personal relationships and provides training for staff in this area. Care plans state service users preferred times to get up and go to bed, although staff explained this is flexible depending on their choices and plans, with one member of staff commenting, “when they get up that’s when the day starts”. Staff were generally seen to knock on doors before entering, although on one occasion a service user was speaking with a member of staff and the inspector in the lounge, with the door closed and a second member of staff walked in without knocking and commenced a conversation without apologising to the service user for interrupting. Staff were seen to interact with service users throughout the day and were able to explain how service users communicate and how to support them with this. Menus planned by the home showed a varied diet offered and the manager stated that mealtimes are varied depending on the needs and wishes of service users. Staff explained that often service users choose something different to that listed on the menu, on some occasions this is recorded and on other occasions it is not. One member of staff explained a service users menu may be planned “ not just on what he doesn’t like to eat but on what he really likes to eat.” Another member of staff was observed to show a service user two tins of soup so she could make an informed choice and a service user explained, “I like pot noodles, and if I want one they are there”. Staff explained that food is bought at local shops and supermarkets and if possible service users go shopping. On the day of the site visit one service user was observed returning home with staff having been to the supermarket. There were sufficient supplies of food available including fruit and vegetables and a member of staff explained that they often make up fruit bowls to eat in an evening. This is not always recorded on menus. The manager must make sure that all meals actually served, including fruit and vegetables served are recorded. This will help to ensure service users are offered a varied, healthy diet to suit themselves. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users health and personal care needs are generally but not always identified and met by the home. Further development is needed to ensure access to regular health checks occur at recommended intervals and changes to a service users needs in any area are assessed for the impact on their personal care needs. Medication is stored correctly by the home however medication records and guidelines need to be of a higher standard to ensure service users safety. EVIDENCE: Care plans record service users preferences with personal care and discussions with staff showed that these are usually followed. However on one living area a service users plan had not been updated following changes in his behaviour. Staff were providing support in different ways with some staff remaining in the bathroom with him and others not seeing any reasons to do so. The manager must ensure that all care plans are up to date so that staff have clear guidance on the support needed. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 16 Good practice was seen in that staff on one living area had provided a high standard of emotional support to a service user who had suffered bereavement. Records evidenced that service users are supported to access healthcare and attend appointments. A previous CSCI visit highlighted that information is not always easily accessible with regards to regular healthcare checks. The home have devised a health action plan for service users which once completed will provide a good guide to ensuring all their healthcare needs are identified and met. Comment cards were received from three health care professionals, all stated that they are able to see service users in private, staff demonstrate a clear understanding of service users care needs and incorporate advice into the care plan. Medication practices differed on the living areas. On some units, medication sheets had missing signatures or signatures made in pencil. It is a legal requirement that entries to medication sheets are permanent. The manager must make sure that all staff are aware of this and that medication is signed for if given and noted if not given along with the reasons why. Staff do not see copies of the GP prescription before it goes to the pharmacist they therefore are unable to cancel unwanted medications with the result that there can be a build up of stock. The home should look at ways of reducing the stock they hold. Written guidelines were in place for some service users for the use of ‘as required medication’ however these were not in place for all service users. Any service user prescribed ‘as required’ medications must have a clear plan in place for staff to follow, this will help to make sure it is given when needed and not used inappropriately. Medication was stored correctly and staff have received training in the safe handling of medication. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home has satisfactory complaints and adult protection procedures in place and this information is available to service users. Polices and practices are in place to protect service users from harm, however the home needs to review the way in which it manages parts of service users monies to ensure their financial safety. EVIDENCE: There is a clear complaints policy in place, which provides information on how to make a complaint about the service. This information is available to service users and their relatives via the service user guide and a service user spoken with explained, “If I’ve got a problem it gets sorted”. However two of the relatives who completed comment cards stated that they were not aware of the complaints procedure. The manager should ensure all relatives are provided with up to date information on their complaints procedure. The manager said that a record of all complaints is held and reviewed by the director, however this was not available for inspection. The responsible person must make sure that access to complaint records is available for inspection by the CSCI. All staff spoken with had had training in the protection of vulnerable adults and staff spoken with had an understanding of how to raise or report concerns. Copies of the organisations and local authority adult protection procedures are available within the home. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 18 Each service user has their own bank account and money available on their living area. There is a small float for each person on the living area and a larger amount held in their locked cash tin. Records and amounts of money checked during the inspection tallied. Service users mobility money is managed in different ways. Some people have a mobility vehicle and their money finances this. Other people have some access to a vehicle owned by the organisation and all their mobility money is retained by the organisation. The organisations financial controller explained that the organisation also pay for any taxis used by service users and that if any service user does not have access to a fleet vehicle then they receive their mobility money. This was discussed with the manager who explained it is an historical arrangement agreed to by the local Primary Care Trust (PCT). However it is possible that the amount of mobility money a service user is paying exceeds their contribution to the running costs of the fleet vehicle and any taxis they use. The responsible person must review the way in which the organisation manages service users mobility money, to ensure it is fair and no individual is contributing an amount that is not in proportion to their access to and use of transport. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 26, 27, 30 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Décor and furnishing throughout the home is variable, some areas are of a good, homely standard, others are not of a standard found in most domestic homes. EVIDENCE: Each living areas operates as a domestic home. The Bungalows have single bedrooms, a lounge, dining room, office, bathrooms, kitchen and laundry room. The standard in communal areas is variable. Some living areas have homely, nicely decorated dining rooms and lounges, one living area was noted to have peeling wallpaper in the dining room, scratched and damaged paintwork in the corridors and no pictures or personal possessions on display. A service user described their environment as “ a tip, tatty, scruffy, not nice”. The majority of corridors have clinical flooring and would benefit from a refurbishment. Some living areas had recently replaced kitchens, on another living area staff advised they had requested a new kitchen as the existing one had marked tiles and cupboard doors that no longer fit. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 20 All areas have sufficient bathrooms and toilets with aids and adaptations available. Bathrooms appear clinical and lack the homely touches found in a domestic home. The responsible individual must arrange an audit of all living areas and identify the work that is needed to make all areas of the environment of an acceptable standard. They must then put together a redecoration and refurbishment plan with dates for completion and ensure this work is carried out. All living areas identified problems with security and youths causing damage, with examples of garden furniture and windows being broken. The organisation has employed a security firm to monitor the premises via patrols and CCTV and had ordered a security barrier for the entrance. All service users have their own bedroom, these are nicely decorated and personalised in accordance with the person’s needs and choices. For example on one living area one service user had sensory equipment in his room, which staff advised they changed regularly to maintain his interest, whilst another service user had a double bed and music and pictures in accordance with his hobbies. Service users commented, “ I like my room” and “my rooms great”. Each Bungalow has its own laundry room with industrial size washing and drying machines. Polices and procedures are in place for the control of infection and there are supplies of disposable gloves, aprons and bags. All staff spoken with had had training in the control of infection. All Bungalows visited were clean. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Recruitment practices and procedures protect service users. The service provides a competent staff team who receive training to effectively support service users. EVIDENCE: Comments from service users regarding the staff team were positive and included, “kind, nice”, “happy, a good friend” and a relative commented “I find the staff very friendly, (my relative) is happy in this homely atmosphere”. Staff spoken with during the inspection had a good knowledge of service users and spent time interacting with them throughout the day. Twenty three of the care staff hold a care qualification (NVQ). The home have not yet reached the national standard of having 50 of care staff qualified to this level. However other staff within the home are currently working towards this qualification. The service has recruitment procedures & policies in place stating they will carry out all required checks before employing new staff. Six staff files were looked at, all had 2 references, identification, application form, interview records, work history, training record, proof of qualifications and supervision and appraisal. No evidence of Criminal Records Bureau Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 22 Checks (CRB) was available; the manager advised these were held by the Director. Evidence of these checks being carried out by the organisation was viewed at the last inspection of the home in March 2006 and a letter was on file for one member of staff requesting information to renew her CRB check, as her current check was now 3 years old. The home has a good training programme in place for staff. The training provided covers a large range of subjects and includes, care qualifications (NVQ & LADAF), medication, health and safety, equality & diversity, moving and handling, communication and adult protection. Training records looked at showed that staff are kept up to date with basic training and supported to go on more specialised training courses. A member of staff explained that if they ask for training is an area that will benefit a service user the organisation will try to arrange this training for them. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home is run by an experienced and qualified manager. Quality assurance systems and plans are in place to develop the service. The home is operated safely. EVIDENCE: Mr Steven Wright is the registered manager of the home. Mr Wright is an experienced Manager in service for adults with a learning disability and holds a care and management qualification. His overall responsibilities are set out within a job description, which meets national standards for care home managers. A quality audit of the service was carried out in January 2006. In addition a business plan has been drawn up for the organisation from 2005 to 2007. This covers a variety of areas including, support to service users, housing and communication and sets service objectives, actions to be taken and responsibilities for improving the service. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 24 Safety records and certificates are in place to evidence that the home carries out regular health and safety audits and ensures equipment is maintained and serviced at regular intervals. Staff receive training in areas of health and safety including fire and moving and handling. Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 3 X X 3 X Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? yes 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 YA22 Regulation 22 Requirement An accurate record of complaints made, details of any investigation, action taken and outcome must be kept at the home to show that complaints are dealt with appropriately. This is a previous inspection requirement. 2 3 YA6 YA7 15(2)(b) 15(1) The Manager needs to ensure all 07/08/06 care plans are up to date and available at all times. The manager must provide a 28/08/06 financial plan for each person, this must include an assessment of whether they can manage their own benefits, look at alternatives to the organisation acting as appointee and state the benefits each person is entitled to and how this is spent. The manager must make sure that all meals actually served, including fruit and vegetables served are recorded. 07/08/06 Timescale for action 24/07/06 4 YA17 17(2) Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 27 5 YA20 13(2) The manager must ensure that any service user prescribed ‘as required’ medication has a clear plan in place for staff to follow. The Manager must ensure medication administration records are completed with a permanent marker and not pencil. The manager must ensure that all spaces on MAR sheets recorded. The manager must develop a system for ensuring large stocks of medication are not held within the home. The responsible person must make sure that access to complaint records is available for inspection by the CSCI. The responsible person must review the way in which the organisation manages service users mobility money, to ensure it is fair and no individual is contributing an amount that is not in proportion to their access to and use of transport. The responsible individual must arrange an audit of all living areas and identify the work that is needed to make all areas of the environment of an acceptable standard. They must then put together a redecoration and refurbishment plan with dates for completion and ensure this work is carried out. 07/08/06 6 YA20 13(2) 31/07/06 7 YA20 13(2) 31/07/06 8 YA20 13(2) 14/08/06 9 YA22 17(3)(b) 14/08/07 10 YA23 20 31/10/06 11 YA24 23(2) 11/09/06 Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA13 YA22 Good Practice Recommendations The manager should look at ways of involving service users more in everyday household tasks, The manager should ensure all relatives are provided with up to date information on their complaints procedure Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Thingwall Hall Nursing Home DS0000005473.V293193.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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