Inspection on 15/07/08 for Thistle Hill Care Home

This inspection was carried out on 15th July 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

Thistle Hill Care Home 17/07/07

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Hawkhills

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Carentan House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Thistle Hill Care Home Thistle Hill Knaresborough North Yorkshire HG5 8LS Lead Inspector Jo Bell Key Unannounced Inspection 15th July 2008 10:00 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and 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. Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thistle Hill Care Home Address Thistle Hill Knaresborough North Yorkshire HG5 8LS 01423 869200 01423 860459 thistlehill@barchester.net www.barchester.com Barchester Healthcare Homes Ltd 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) Manager post vacant Care Home 85 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (41), Old age, not falling within any other of places category (24), Physical disability (20) Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users in the category (PD) must be accommodated in the younger disabled unit on the ground floor. Service users in the category DE(E) must be accommodated in the dementia unit on the first floor. One named service user (subject of application for variation V31276) in the category DE may also be accommodated within this unit. Service users in the category (OP) and those service users in the category (PD) who are a. Over the age of 55 years and b. who require nursing care may be accommodated in the elderly frail unit on the ground floor. 17th July 2007 3. Date of last inspection Brief Description of the Service: Thistle Hill Care Home is a recently built service for up to 85 service users. The home is split into three separate units. These being a 41-bedded dementia unit (Deighton), a 24 bedded nursing unit (Ripley) (both for older people) and a 20-bedded younger adults unit (Farnham). All the bedrooms have en suite facilities and there are dining and communal areas on each unit. The home is located on the outskirts of Knaresborough, which has the amenities expected of a small town, as well as rail transport links with York and Harrogate. The home is in its own landscaped grounds with level access and ample car parking. The home’s current weekly fees are between £750-£1200 (July 2008) with additional charges for hairdressing, chiropody and toiletries charged at individual costs. People are made aware of the home’s Statement of Purpose, service user guide and latest report written by the Commission for Social Care Inspection. This is discussed when people first enquire about the service and details are given to people once admitted. Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Commission for Social Care Inspection inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.csci.org.uk This is what was used to write this report. • Information about the home kept by the Commission for Social Care Inspection. This includes a random visit undertaken on 14th February 2008, which looked at two previous complaints, and the requirements previously made. A further requirement and recommendations was made at this time and these have since been addressed. Information asked for, before the inspection and usually provided by the manager. This is called an Annual Quality Assurance Assessment (AQAA) Information from surveys, which were sent to people using the service, relatives and other professional people who visit the home. 8 were returned from people using the service. 2 were returned health care professionals A telephone discussion was held with 1 healthcare professional, which provided their views about the home. An expert by experience (a member of the public who has had some involvement with care homes) spent time speaking with people using the service and some relatives. This information was fed back to the inspector and the manager. A visit to the home by one inspector, which lasted about 7 hours. This visit included primarily observing how staff respond to and support people living there. Staff were spoken with about their work and training they had completed. The visit also included checking some of the records, policies and procedures that the home has to keep, and looking at previous complaints and concerns raised. • • • • • Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 6 Information about what was found during the inspection was given to the registered manager during the visit. There are no outstanding requirements and at this visit one requirement and one recommendation was made. What the service does well: What has improved since the last inspection? Staffing levels have been reviewed to meet changing dependency levels. A resident’s forum has been commenced with ideas and views coming from the people attending the meeting rather than the staff of the home. Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 7 The courtyard garden has been established for people to enjoy. One survey received stated, “I think Thistle Hill has improved greatly over the past 3-5 years. I always find that the staff are very attentive to their residents” 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. The summary of this inspection report can be made available in other formats on request. Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Older people - 3 and 6. Younger adults - 2. (Standard 6 is not applicable) People who use this service experience good quality outcomes in this area. The pre admission assessment ensures that individual care needs can be met at the home. The prospective resident receives information and help, to enable them to choose whether Thistle Hill is the right place for them. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Older people and Younger adults Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 10 All people prior to admission have their needs assessed using a ‘total assessment document’ This covers social, nursing, health and psychological well-being. The manager of the home carries this out. Those people Who are funded through social services have an additional assessment undertaken by a care manager. All eight surveys returned stated that people receive enough information about the service. One comment was “the office and nursing staff were very helpful when I visited to view the home. I was given a cup of tea and made very welcome”. The manager is aware of the different needs clients have. This may be mental, physical or social need. The home has to accommodate both younger adults and older people. The home not only considers the individual’s needs when assessing someone new but also how they will fit into the home and interacts with other people using the service. People spoken with on all units confirmed that someone had discussed their care needs with them prior to being admitted to the home. Four pre-admission assessments confirmed that detailed written information is obtained on all aspects of a person’s life. This helps to inform a care plan for staff to use. People are given terms and conditions and a contract, which is signed by the person using the service or a person on their behalf. The administrator keeps copies of this information. Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Older People - 7, 8, 9 and 10. Younger adults - 6, 9, 16, 18, 19 and 20. People who use this service experience good quality outcomes in this area. Health and personal care needs are well met. People are supported to take risks and privacy and dignity is maintained. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 12 In all three units of the home people confirmed that their health and personal care needs were being met. Four plans of care were inspected. These recorded very clearly daily routines of people, the individual needs and the care needed in relation to social care, health and personal care. The random visit in February 2008 confirmed that There are plans in place to help staff understand what help people need with their individual personal care, hygiene and grooming. One plan included records made by the dentist, which commended staff on the ‘excellent oral hygiene and dental care’. Another explained the approach that should be taken by staff to assist one person who does not always like to change their clothes at the same time of day as everyone else. The plan had been agreed with the person’s family, and the daily records showed that generally, this care plan was working, and that the person received adequate personal hygiene care. At this site visit people looked clean and well cared for with nails cleaned, hair brushed and gentleman shaved. Care plans are reviewed and evaluated on a monthly basis. An audit of the care plans takes place as part of the quality assurance system. Staff were spoken with on each unit and had a clear understanding of the needs of both younger adults and older people. A key worker system is in operation and some people were aware of who their key worker was. Throughout the units there was evidence that people were getting up at different time and routines were flexible depending on the individuals needs. Records in the care plans identified risk assessments for moving and handling, nutrition and the prevention of pressure sores. Staff knew which people were at risk of being undernourished and the dietician was referred to when necessary. Doctors visit the home and the staff have worked hard to improve communication. One survey returned felt that this area needs to be improved on. Another professional survey stated, “There are some occasions that staff are not up to date with the latest practice. However, once staff are informed they take appropriate action”. The home has access to a continence advisor, tissue viability nurse (a person who deals with pressure sores and ulcers) and infection control advice. Evidence of input from the community mental health team was in place and this was discussed with the manager on the dementia unit. The home deals with accidents effectively. These are recorded in an accident book and in individual care plans. The CSCI is notified of any incidents adversely affecting people shortly after they have occurred. The random visit stated, “Accidents reported in the accident book were also noted in people’s daily care records. Staff get a report before they begin their shift, so that any incidents or recorded changes in care can be passed on. Evidence was seen in two out of three plans that family members had been consulted when their relative had suffered a fall, or sustained an injury”. The medication system was inspected in all three areas of the home. A procedure is in place, which staff adheres to. Staff are trained in how to administer, record store and dispose of medication. Staff discussed fridge Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 13 temperatures, controlled drugs and safe disposal of these. Medication charts were effectively maintained and the controlled drugs register was up to date with two people signing for controlled drugs. A monitored dosage system is used and stock balances are taken on a regular basis. People have their medication administered safely. No concerns were raised in this area. Privacy and dignity was observed. People are spoken to in a pleasant manner and are addressed appropriately. People have personal possessions in their room and this was observed on all units. Surveys confirmed that privacy is maintained and this was evident during the visit. The expert by experience on one occasion observed a member of staff knocking on a door and entering straight away. This would not give the individual time to prepare them to receive visitors. This was discussed with the manager. Expert by experience I spoke to four residents and two visitors in the Nursing Unit and a visitor in the Dementia Unit and chatted with one or two more residents whilst having lunch with them A member of staff was sitting with one resident as I entered the Lounge and they were chatting together quite comfortably. This resident came often for respite care and said she had settled in well. She was very satisfied with the home and her care and seemed very content. Another resident had difficulty speaking but seemed very settled and his relative and visitor confirmed this. The relative and visitor I spoke to in the Nursing Unit were both extremely happy with the care, the home and the staff. The relative emphasised she was always notified if the doctor was being called out and what had been said and felt she knew what was happening regarding his care. She found it very reassuring that checks were made through the night and she showed me the chart in his bedroom showing the time of checks with comments e.g. “comfortable”. She had had discussions with staff regarding her husband’s care and had signed “something” (care plan?) about his care and consent to bed rails which had also been discussed with her. I spoke to a resident’s relative in the Dementia Unit who was really pleased with the home and the care her relative received and said “the staff were lovely”. She also felt they had privacy. She mentioned in particular how “beautifully they cut and kept his nails” He had also had a neck massage. Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Older People - 12, 13, 14 and 15. Younger adults - 12, 13, 15 and 17. People who use this service experience good quality outcomes in this area. People are satisfied with their day-to-day life and the standard of food provided is good which people enjoy. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home provides a range of activities. There are trips out for groups of people from all units. Currently there is an additional charge of £8.00 per person per hour if an individual wishes to go out somewhere for the day. This Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 15 was discussed with the manager and people from the younger adults unit confirmed this was the case. A new activities organiser is due to start working at the home. Surveys had mixed responses regarding activities. One person stated how they enjoyed music. People go out into the garden and enjoy spending time outside. The younger adults unit has a large screen television with SKY, the sports channels are very popular though a compromise was reached regarding how often the television is on and whether it is appropriate to watch television during mealtimes. On the dementia unit staff obtain life histories of people to identify what role they had prior to being admitted into the home. This helps staff to meet people’s needs. Comments in the surveys included “we would like more activities and entertainment”. There is a shortage of books and magazines for people to look at. Some people said that only “sometimes” there are enough activities. The manager can easily address these issues. Staff encourages autonomy and choice. Routines are individualised and this was confirmed when speaking with people. One person said, “I get up and do what I want during the day”. An advocacy service is available for people on the older people’s units. Staff are aware of the mental capacity act and how to act within this. Religious needs are discussed in the care plan, though staff do need to ensure this information is fully completed. Visitors are welcomed at any time. One person visiting confirmed that staff have accommodated their specific needs regarding their gender and sexual orientation. This has been discussed with staff to ensure the person using the service needs are being met. The lunchtime meal was observed by the expert by experience on the nursing unit and on the dementia unit by the inspector. Mealtimes were relaxed with staff assisting people in a dignified manner (evident on both units). The dining rooms are light and airy and the menus vary depending on the age and need of the person. For example on the younger adults unit during the evening there is scampi, pizzas, burgers or pasta available. Whereas on the older people’s units people have a hot meal at lunchtime and a cold meal is offered at teatime. However, anyone on either units can have the same choice. People have access to a range of drinks and the mealtimes are staggered to ensure people get the help they need in an unhurried manner. People commented in the surveys regarding the food available. Some people said they “sometimes” like the food, whilst others stated they “always” like the food. The meals observed looked appetising. Portion sizes were suitable and a choice of food was available. Expert by experience Mid-morning drinks were served and residents were offered a choice of both hot and cold drinks. All the drinks were put on tables nearby so the residents Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 16 could reach them. There was a table in the Lounge on which there were jugs of juice and glasses and a water cooler and there was a used empty glass standing on one of the tables All the residents I spoke to said the meals were very good and wine was offered. I ate lunch with the residents in the Dining Room of the Nursing Unit. The tables were very nicely set with table cloths and the food was hot and nicely served. There was a menu on the table and the choice was made at the table. There was a choice of hot meals or salads and a choice of starter and sweet. The Catering Manager said they could offer an alternative if there was nothing to suit provided they had the ingredients. Both the Catering Manager and staff took time to discuss the Menu with the residents and explain what some of the meals were. The staff seemed familiar with the food likes and dislikes of the residents but said they did not take it for granted that is what they would always want and always discussed the meals with the residents. Some residents were having their lunches in a separate lounge assisted by staff on a one to one basis. The staff were talking to the residents and did not appear to be hurrying them with their meals. One lady preferred to have here meals in her room and this was accommodated On the table I sat for lunch one resident was being assisted by a member of staff who sat at the table and talked to the resident and to us all. The atmosphere at the table was friendly comfortable and unhurried and the resident being assisted with his meal blended in with us all. The Catering Manager said she would be made aware of people who were diabetic and whose blood sugar reading was high. Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Older people 16 & 18 Younger adults 22 & 23 People who use this service experience good quality outcomes in this area. Residents and their families can be sure that complaints are taken seriously and staff are alert to any signs of abuse, so that people living at the home are protected from harm. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home have a detailed complaints procedure in place. During the past twelve months, six complaints have been received, one of these was upheld. A random inspection found that the home needed to have a more robust communication system in place. Half of the complaints dealt with by the home were resolved within 28 days. This was confirmed in the annual quality assurance assessment. The home has a complaints book available in reception where people can write any concerns down. The manager encourages an ‘open door’ policy where people can access her at all times to discuss any issues. Out of eight surveys returned, only one stated they were not aware of the complaints procedure. This was an older person. People look safe in the home and the risk of harm is minimised through staff having abuse awareness training. A whistle blowing policy is in place and staff are aware of the different types of abuse a vulnerable person may be Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 18 susceptible to. Two safeguarding referrals have been made, one has been concluded though one has been referred but no investigation has taken place. This is due to social services not completing the investigation. However, this should have been followed up by the manager as over four weeks have passed which means the family of this person does not have a satisfactory outcome. Older people People who were spoken to on the nursing and dementia unit were aware of how to complain. One comment was “I would speak to the staff if I had any problems”. There is also an advocacy service available for people who may need someone to speak on their behalf. The surveys confirmed that people feel staff will listen to and act on what they say. Staff were observed moving and handling people safely and talking with people in a pleasant attitude and manner. Younger adults People on this unit could vocalise very well their views and opinions regarding the service. Meetings take place where concerns and issues are raised and people appeared to have a good rapport with staff. Expert by Experience None of the residents or their relative/visitors I spoke was aware of a complaints procedure but all said they would complain if there was a problem and felt it would be addressed. They would complain either to the Manager or to a member of staff . One resident said he had merely made a comment in passing about his bed not yet being made and this had been addressed. Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Older People - 19 and 26. Younger adults - 24 and 30. People who use this service experience good quality outcomes in this area. People live in hotel style accommodation, which is extremely clean and well maintained. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 20 Thistle Hill is a purpose built home with separate units for younger adults, older people with nursing needs and older people with dementia needs. The accommodation is hotel style and varies depending on which unit you look at. There is a programme of routine redecoration and maintenance and all areas of the home that were inspected smelt fresh and clean. All staff have completed infection control training and protective clothing is worn at mealtimes or when personal care needs are being addressed. Staff know how to wash their hands effectively and sluice areas and laundry were well maintained. Different coloured bags are used for washing soiled or unsoiled clothes and bedding. Older people Two bedrooms were inspected on the nursing unit and on the dementia unit. These were en-suite and the beds were specialised for people with nursing needs with integral bed rails if needed. Pressure relieving mattresses were in place and suitable moving and handling equipment was evident. People had enough space and positive comments were made regarding the environment. All surveys returned stated the home is clean and fresh smelling. One comment was “the home is very well kept, cleaners always working. Very well furnished with the touch of home”. Previous discussions have taken place regarding the suitability of the dementia unit being on the first floor. This makes it difficult for people with dementia to access the garden. Younger adults Two bedrooms were inspected, many personal possessions were evident. One person said, “I enjoy having a shower”. Another person had a flat screen television and football memorabilia. Six ceiling hoists have been obtained and a further one is being obtained in the next few weeks. This will help people move safely around the bedroom with the help of staff. Wheelchairs with pressure relieving cushions were observed and people were able to manoeuvre these effectively due to the wide corridors and wide doors. The new unit manager discussed how it would be beneficial having higher tables in the dining room so wheelchairs can fit underneath. The manager is very aware of how the environmental design can impact on people with dementia. On this unit there are pictures details of life history to help orientate people and different colours so people can identify where their room or the toilet or communal areas are. The dementia unit is shortly going to change and in the future there will be the capacity to admit people who have high dependency needs. The layout will change to ensure these needs can be met. Consideration has been given to the age difference between 18-65 year olds and those people over 65. This was evident when inspecting all areas. Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 21 Expert by Experience All the residents were nicely and appropriately dressed and care seemed to have been taken in their dress and appearance. The Lounge and Dining Room and common areas were all pleasant clean spacious and airy and not overcrowded and there were no stale smells. The resident’s bedroom I visited was also clean tidy and fresh with a few personal possessions and pictures in the room. Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Older People - 27, 28, 29 and 30. Younger adults - 32, 34 and 35. People who use this service experience good quality outcomes in this area. People are cared for by well-trained, skilled and knowledgeable staff, which have a good understanding of their roles so that the care provided is safe and consistent. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Throughout the home there are sufficient staff that are suitably trained to meet a range of needs both for younger adults and older people. Five out of eight surveys stated that the staff are always available when needed, with three stating staff are usually available. On the dementia unit there is a new unit manager (2nd day) and on the younger adults unit a registered nurse was appointed five months ago. The home has a diverse staff group. There are Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 23 male and female staff from a range of ages. Some staff are South African, Chinese and polish. The home works hard to ensure they communicate effectively and are given support to develop. Older people Many of the staff on the nursing unit and dementia unit have worked at the home for some time. They have a good understanding of how older people should be treated and the nursing conditions they have. There are forty-one people on the dementia unit and twenty-four people on the nursing unit. The dementia unit will shortly include up to fourteen people who have high dependency needs. The manager is aware that staffing levels need to be reviewed in order to meet the increasing needs of this client group. Staff are competent in dealing effectively with a range of situations. One person had a fall and staff knew what action to take to prevent further harm. Reassurance was given and the person was moved safely. Staff were calm and in control. Staff have had specific training in dementia care and challenging behaviour. Younger adults The unit manager is a general nurse who has cared for older people in the past. People using the service are generally able to express their needs. Staff have a good rapport with people on this unit and are keen to meet their needs. As this is on the ground floor people are able to access the garden more readily than those on the first floor. The unit can have up to twenty people. Staff tend to work solely on this unit, which helps to ensure consistency. One person said, “staff are here to help but I like to be independent”. The home has a robust recruitment system in place. This helps to protect people from harm. Three files were examined and these contained two written references, a police check along with a protection of vulnerable adults check. Registered nurses have their registration records checked and this was evident in the staff files. The manager is aware of how to recruit, interview, select and employ a new person. An induction process is in place, which has to be completed. This covers aspects of care practices and health and safety and is equivalent to Skills for Care (formerly TOPSS). Many staff have an NVQ level 2 or 3 in care and this helps to ensure staff are trained to the same standard of care. Expert by Experience All the staff on the Nursing Unit were very friendly to residents and visitors and those I heard speaking to residents were polite. I also noticed whilst staff addressed most of the residents by their first names one person was addressed as “Mr”. There appeared to be plenty of staff and I noticed staff taking time to sit with a resident for a few minutes or stopping to talk with them or their visitors. The staff appeared to have time for the residents and never Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 24 appeared to be hurrying them. One resident was taken out into the garden in her wheelchair by a member of staff. The atmosphere between the staff also appeared to be very friendly Several of the residents were lifted out of their chairs by hoists and those I saw seemed quite at ease with the procedure. The staff appeared to work together as a team during this procedure and took time with the residents and there was no feeling of the residents being rushed Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 26 Older People - 31, 33, 35 and 38. Younger adults - 37, 39 and 42. People who use this service experience good quality outcomes in this area. People living at Thistle Hill and their families are central to the development of the service and management recognises safe working practices as paramount to protecting people and staff. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Older people and younger adults A general manager who is registered with the CSCI runs the home; she is supported by three unit managers and a team of registered nurses (both general and mental health trained). The manager is professional, approachable and is an experienced care home manager. People spoken with throughout the home had confidence in the manager and her abilities to run the home effectively. Resident’s forums have been commended and regular meetings take place. The people using the service on the younger adults unit are responsible for organising their own meetings any ideas or views are then discussed with staff. Meetings take place on the nursing and older people’s units where relatives are invited to contribute. The home have a detailed quality assurance system in place. Surveys are due to be sent out in September 2008 to seek views and opinions of the service. Verbal information is sought on a daily basis regarding any concerns people have. A robust audit system is in place, which covers care practices and health and safety. A monthly audit takes place, which is known as Regulation 26 visits and a compliance officer has been employed during the past 12 months to look at how the home is meeting people’s needs. People are given clear information regarding how their finances will be dealt with by the home. This was inspected and was found to be comprehensive. Records were checked and individual information is available with people able to keep a small amount of money at the home. There is a residents fund for activities and invoices are sent to people for chiropody, or hairdressing. The administrator deals with finances in an efficient and effective manner. Health and safety was discussed. A robust system for auditing all aspects of health and safety is in place. Quarterly health and safety inspections take place and risk assessments are put in place and reviewed. Policies are reviewed and the annual quality assurance assessment confirmed that regular checks are in Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 27 place. These relate to maintenance of equipment, lifts, hoists and the call bell system. Fire safety was inspected. A fire risk assessment is in place and up to date and people have fire training with fire tests and fire drills in place. It was evident that the electrical wiring certificate showed that the emergency lighting was not fully operational. This has been outstanding since April 2008, the manager is aware that this needs to be fully working to ensure people’s safety in the event of a fire. Staff records were inspected and individual training files confirmed that mandatory training includes moving and handling, fire safety, infection control, health and safety, safeguarding adults and first aid. Barchester also offer specific training, which helps staff meet individual needs. Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 x 3 3 4 x 5 x 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 ENVIRONMENT Standard No Score 19 4 20 x 21 x 22 x 23 x 24 x 25 x 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 x 33 3 34 x 35 3 36 x 37 x 38 2 Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 29 No 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 OP38 Regulation 13 Requirement The emergency lighting must work effectively at all times. This will ensure fire procedures are adhered to which will help maintains peoples safety. Timescale for action 15/08/08 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 OP12 OP18 Good Practice Recommendations A review of the activities on the nursing unit should take place. Safeguarding investigations need to be progressed in a timely manner. This will help obtain an outcome, which can be actioned. Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: 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 © 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. Thistle Hill Care Home DS0000069350.V368274.R01.S.doc Version 5.2 Page 31 - 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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