Inspection on 17/07/07 for Thistle Hill Care Home

This inspection was carried out on 17th July 2007.

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 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 15/07/08

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Hawkhills

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Carentan House

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Thistle Hill Care Home Thistle Hill Knaresborough North Yorkshire HG5 8LS Lead Inspector Jean Dobbin Unannounced Inspection 17th July 2007 09:30 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.V343636.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.V343636.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 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) Barchester Healthcare Homes Ltd vacant post 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.V343636.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. New Service 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. Details provided in May 2007 state that the weekly fees are between £750 and £1200. Additional charges are made for hairdressing, chiropody services and individual items like newspapers, toiletries and taxis. The service provides information about the home, including previous CSCI reports, to prospective residents. New residents receive a Welcome Pack, which gives information about the home. Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection. This is called a Pre Inspection Questionnaire. (PIQ) Information from surveys, which were sent to people who live at Thistle Hill, their relatives, and other professional people who visit the home. 20 were sent to people at the home. (8 of these were in a picture format) and 11 were returned. 16 were sent to peoples’ relatives and 11 were returned. 3 were sent to GP’s and 3 to Care Managers and 1 was completed and returned. A visit to the home by two inspectors, which lasted about 7.5 hours. This visit included talking to residents and visitors, and to staff and the manager about their work and training they had completed. It also included checking some of the records, polices and procedures that the home has to keep. One inspector undertook an assessment where she sat for 2 hours on the dementia unit observing the people who live there to assess both their well-being and how the staff interact with them. What she saw is included in the main part of the report. • • Information about what was found during the inspection was given to the general manager at the end of the visit. What the service does well: The Younger Adults Unit has been accredited by the Multiple Sclerosis Society, which means the charity has assessed that they provide very good care to people with MS and are happy to recommend the home. A comment from a person who had spent some time there was “I have had a good time and give you the mark of 9½ out of 10. You look after people with MS well”. The care planning records are written in discussion with the person who lives there and their family as much as possible. This means that people have the chance to say what is important to them, as well as making sure they stay in charge of their own life when they can. Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 6 The assessment carried out on the dementia unit showed that the way the unit is run allows people living there to maintain choice and control of their lives as far as possible. They are cared for as individuals, with dignity and respect. The home is maintained and decorated to a high standard. This enhances the environment for the people who live there. The large, enclosed patio garden is particularly attractive and is clearly used a lot by the people who live there. The service is very receptive to peoples’ views about how things could improve. Suggestions made by, or on behalf of the people who live there are taken very seriously and where reasonable are acted on. This shows that the home wants people to influence both how the home runs and the facilities it provides. What has improved since the last inspection? This is classed as a new service because Barchester Healthcare has reregistered all their homes earlier this year. However there have been no fundamental changes in the way the home operates as a result of this new registration. It is therefore reasonable to comment on improvements made since the last inspection in January 2007. The service is now working more as one big home. Whilst staff are still employed in a particular part of the home the culture of the home encourages staff to support each other more and not see short-term difficulties in another unit as ‘not my problem’. Staff were seen outside of their normal unit chatting with people they were less familiar with. Encouraging this team spirit raises staff morale, makes people feel valued and means staff are more likely to support colleagues willingly and with enthusiasm. The care plans on Ripley Unit are now much better. They are now written in discussion with the person or their family and clearly describe how one person’s needs are very different from another. They also show that care staff are encouraging and helping people to have some control of their lives. There are now assessments in place on Ripley Unit, which identify those people at risk of coming to harm so that measures can be put in place by the home to reduce that risk. The catering service has improved and staff are aware that other meal options are available if people don’t like what’s on the menu. People think the food is better than it used to be. One comment was that they “enjoy their cooked breakfast with two eggs”. The service have identified ‘English speaking courses’ which care staff whose first language isn’t English are supported in attending. A number of staff were spoken with on the day of the visit. All had much better language skills than at the last visit so that communication with people at the home is easier. Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 7 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.V343636.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.V343636.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. 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 All the care plans looked at contained an assessment completed before the person moved to the home to confirm that staff would be able to care for them Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 10 properly. These were completed in good detail and described their physical, emotional and social needs. A senior nurse assesses those people planning to move to Deighton or Ripley. When the last inspection took place six months ago a visitor confirmed this pre-admission process and said they also visited, were shown around the home and given information to take away and read. All people expressing an interest to move there are given information to read and those who move to the home are given a Welcome booklet about what services are available at the home. One care plan described a person who was admitted regularly for short stays. Although their initial assessment was detailed there was no indication that this was looked at before each admission to check that the person’s needs had not changed. Intermediate care is not provided at Thistle Hill. Younger Adults The manager of the Younger Adult Unit carries out her own assessments before agreeing to someone moving there. This is not only to check on the needs of the individual, and confirm that staff can meet those needs. She also feels its important that the person will fit in with the culture of the unit and the people who are already living there. This nurse was carrying out an assessment on the day of the visit. One person’s care needs, who had previously lived at the home, had changed and training sessions were organised at the local hospital so that staff would have the skills to be able to care for them again. One carer said at the last inspection in January that people’s care needs were discussed in detail by all staff before they arrived so that everyone would know what to do when they moved there. Thistle Hill Care Home DS0000069350.V343636.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. Whilst health and personal care needs are well met, there are still some shortfalls in medication practice, which means people may not always be receiving their medicines as prescribed. We have made this judgement using a range of evidence including a visit to this service. Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 12 EVIDENCE: Older People Three care plans were looked at on Ripley Unit. There has been significant progress made by the staff to make these plans more individual to really show that everyone has very different needs. For example one record described how a person likes their room light on the dimmest setting at night, likes their door half open and likes to switch their own bedside light off. Another person’s records said that they did not want their meals cutting up. This individualised support helps people to stay in control of their lives and reminds staff to recognise and encourage people’s independence. Risk assessments were carried out to identify which people were at risk of developing bedsores, of having repeated falls, or becoming malnourished because of health problems or poor appetite. Plans to say how these risks were to be minimised were generally reviewed monthly. The care records were checked monthly and had generally been signed by either the person or their family member to show that they agreed with what was written. Records looked at however showed that these could still be improved on. For example one person had had a stroke and the records did not describe what kind of help they needed in order to move safely from one place to another. Another person had signed to agree to their cigarette lighter being removed each night because of a fire risk and this was being done without telling them. However records said that they had a very poor memory, so were unlikely to remember signing the form. Staff should not be removing people’s possessions without their agreement. This was discussed with the nurse in charge and the manager. One record looked at on the dementia unit confirmed what was found at the last inspection six months ago, where records were noted to be very detailed and completed in a way that recognised peoples’ abilities and needs. They had been completed in consultation with the person, where possible, or their family member. Medication processes were looked at on Ripley Unit. Whilst drugs are now stored correctly, there are still some shortfalls. One drug, which was to be given regularly, had run out several days earlier. The pharmacy had a problem obtaining this item however the person’s GP had not been informed in case they wanted to prescribe a different drug in the meantime. Another drug, prescribed ‘as required’ had also run out several days earlier and had not been re-ordered. Non blister-packed tablets were not being counted regularly to make sure that the actual number of tablets was the same as the predicted Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 13 number. This would confirm that these drugs are being given according to prescription. All other records and processes were satisfactory. There was evidence in the records of referrals and visits from healthcare professionals. The survey completed by the GP showed no concerns. A GP visited a person on Ripley on the day of the visit, and whilst this person was seen in their own room with a nurse present, their door was partially open. This did not protect the privacy and confidentiality of the person involved. Carers were observed speaking kindly and gently to people on both units. People looked well cared for and those spoken with said that they were happy living there. Care staff on Ripley unit seemed to have more time than at the last visit. They were able to talk and sit with people and helped some to go outside to enjoy the fine weather and the gardens. One comment from a relative on Deighton said. “At last my relative is treated with dignity and charm. This is my fourth experience of care and outstrips the others by miles”. There is a key-worker system in place and carers spoken with had a good understanding of their role. There is no key-worker documentation though, to enable carers to record the work that they do. This was discussed with the manager. Younger Adult On Farnham the records looked at in January 2007 were very detailed and encouraged choice and independence, as well as supporting people to make decisions. One care plan was looked at briefly on this visit. The resident had largely written this themselves, with the nursing staff signing their agreement and support. The unit manager explained that they had good links with healthcare professionals and since they had been awarded Preferred Provider status for MS Society they had become busier, requiring even closer contact with specialist healthcare support. There are a number of people who have regular short stays on the unit. Comments from some of these include “I would like to stay for longer” and “… has enjoyed their stay and has been well looked after”. The manager explained that she does the medicine round, several times a week, as a way of checking the drug record sheets completed by other staff and checking that drugs have been given appropriately. People are treated very individually on this unit and the people who live there set the routines. Staff wear polo shirts rather than a carer’s uniform to make the unit seem more homely. Thistle Hill Care Home DS0000069350.V343636.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 at the home has improved so that people enjoy their meals more. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 15 There have been changes in the catering services at the home as concerns had been highlighted at the last inspection. An experienced head chef is due to start work within the month. A new Hotel Services Manager has also been employed who starts work very soon and will develop this side of the service including improving the menus and the dining experience. New hotel services staff due to be recruited will also mean that care staff will be able to concentrate on direct care giving. Fresh fruit, as well as home baked cakes, are offered every afternoon. The chef on duty had a good knowledge of how to fortify foods to make sure that people at risk of malnourishment, for various reasons, were able to have enough calories. They explained that they regularly cooked meals that were not on the menu, to meet peoples’ individual requests. Quarterly residents’ and relatives’ meetings have been restarted to allow people to influence how the home is run. These meetings are minuted and displayed around the home. Older People Visitors are welcomed at any time and the visitor’s book confirmed this. There is one activities person working on the dementia unit. She has good knowledge of the people who live there and knows what interests them and how long they can concentrate on different activities. This means she is able to tailor her work according to which people she works with. A second activities person was on Ripley and was observed carrying out hand massage and talking to one of the people, outside in the garden area. Other activities on the pictorial programme included a weekly visit from a PAT dog, arts and crafts and weekly trips out to lunch in the home’s minibus. People spoken with said that they chose how to spend their time and survey responses confirmed this. Newspapers are delivered to the home, both for individuals and general use. Lunch on Ripley was a relaxing, social occasion. The dining room was attractively furnished and the tables had cloths and fresh flowers. The menu was displayed. One person though was unable to read the menu because of their poor eyesight and this was discussed with the nurse in charge. People were offered wine and the meal is chosen at the table, rather than earlier in the day. Four people spoken with said the meals had improved and were “very nice”. They said they could ask for an alternative if the menu did not appeal however said this situation had never arisen. There were enough staff to assist in a discreet manner, indeed two people were helped to have their meal outside in the sun. Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 16 Younger Adults On Farnham staffing numbers are adjusted to allow people to maintain links and interests in the community. For example two people went to the cinema recently, fortnightly visits to the swimming pool take place and one person goes clothes shopping very regularly. One person commented in the Comments Book that they “went to the Squinting Cat and thoroughly enjoyed their tikka masala”. The unit manager thinks that diverse interests should be met individually, rather than use the minibus. This supports the ethos of the unit where people are supported in maintaining as normal a life as possible. There is no activities person based on this unit however the manager plans to address this. One comment in the survey said they wished there were “more social activities, which would prevent boredom, as there is little opportunity to socialise with other residents”. There is an alternative therapist who visits weekly to provide treatments. A computer with broadband is available in the lounge to help people living there to keep in touch with their peers. The dining area has been altered to provide accessible tea/coffee making facilities for wheelchair users and visitors, as well as providing light snacks to provide a homely environment and encourage independence. Thistle Hill Care Home DS0000069350.V343636.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 and 18. Younger adults - 22 and 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 complaints process is displayed in the entrance area and advocacy leaflets about services in the local area are also on display. Those people spoken with said that they would complain either to the nurse in charge or the manager if they had concerns. One person said they had met the new manager. They could not recall her name but felt they would be able to talk with her. Staff spoken with also said they would feel able to talk with the new manager. The surveys returned from people living at Thistle Hill said that many of them knew how and to whom a complaint should be made if they were unhappy about something. This is better than at the last inspection when more than half of those people said they were unaware of the home’s complaints process. Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 18 There have been three complaints to the home in the last few months, which had been dealt with appropriately and records kept confirmed this. One complaint alleged some possible abuse and this too had been dealt with appropriately with advice taken in line with North Yorkshire Social Services guidelines. One staff member spoken with was very clear about their responsibilities should they hear or see something they are concerned about. Other staff confirmed that Safeguarding Adults training is provided when they start working at the home. Recruitment processes are generally robust, (See Standards 27-30) and no-one starts working at the home until all checks required by law have been completed. These systems are in place to protect people from harm. Younger Adults This area was not inspected on this unit. One person spoken with however said that the head of unit was very accessible. When these standards were looked at in January 2007 staff and residents were very aware of how to complain if they were unhappy. One resident said that they would speak with the unit manager, as they knew she would sort it out. Staff also said they would feel comfortable talking with their manager and knew the problem would be dealt with properly. Thistle Hill Care Home DS0000069350.V343636.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 a clean and well-maintained home. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 20 Thistle Hill Care Home is purpose built and has been open for about 2 years. It provides attractive and modern accommodation on two floors in three separate units. It is bright, and comfortable, with lots of pictures and soft lighting, and a number of different seating areas. The dementia unit is on the first floor, accessed by a vertical passenger lift, with the nursing and younger adult unit on the ground floor. It is set in its own grounds, which provide level access and there is an enclosed paved garden area with seating and an arbour. This area is very attractive, with raised flowerbeds, a small vegetable patch, tended by a person living on the dementia unit and a large koi carp pool, which is currently being built. This area has access from the two downstairs units and was being used by several people on the day of the visit. The home is clean and well maintained and carers spoken with explained how staff prevent the spread of infection around the home. They said they had attended training in this. They also said that there were enough aprons and gloves at the home and said it was part of their key-worker role to make sure this equipment was ‘topped up’ in people’s private rooms. Staff were observed wearing aprons when carrying out personal care. Older People The dementia unit is becoming a ‘Memory Lane’ unit. This means it in introducing features and decoration that are more familiar for the people who are now living there. This includes older style furniture and accessories as well as themed areas, like a nursery. It is decorated in such a way as to make it easier for people to find their way around The doors have large numbers and pictures to make them more memorable for the people who live there. Chairs are arranged in small groups to encourage communication and make the unit more homely. Other plans like an indoor garden and a lifestyles kitchen, where people can carry out normal domestic tasks, are to be introduced. On Ripley many people choose to stay in their own rooms, which are personalised with photographs and other effects. People were observed reading a newspaper or book and listening to the radio. There is a large sitting area with daytime television and a smaller quiet room. It would be useful if there were some occasional tables available in the lounge for people’s drinks and other personal items. This would help people to maintain some independence and control in their day-to-day lives. Younger Adults This unit was not looked at, however in January this year it was noted that the unit is designed with wide corridors and doorways to facilitate access for wheelchairs and moving equipment. Specialist bathing aids enable individuals with different disabilities to bathe if that is their choice. The private rooms are Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 21 a good size and are all very different according to the individual’s interests and personality. The lounge and dining room are more widely used than on previous visits. The unit is going to buy a large fish tank to promote a relaxing environment there. The outside area is to have more paving so that people in wheelchairs can get to the new fish pool. (Score 3) Thistle Hill Care Home DS0000069350.V343636.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, who 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: Two recently employed staff files were looked at. Whilst one file contained all the checks necessary before a new employee starts work, there were no references in the other. This person had been employed from overseas and the file contained a letter saying that references had been received and verified, by someone from the company’s central recruitment office. The manager needs to satisfy herself that recruitment processes, carried out Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 23 centrally, are satisfactory. This was discussed with the manager, who was aware of this ruling. Police checks, to make sure individuals are not barred from working in a care environment because of a previous offence, are completed before someone starts working at the home. These practices protect people from possible harm. There are a number of staff working at the home whose first language isn’t English. Several survey responses commented that communication can sometimes be difficult. However on the day of the visit the two inspectors spoke with a number of care staff and unlike at the last inspection, communication was not difficult. Likewise conversations between staff and residents appeared relaxed. One staff member explained that they were attending English-speaking classes at Harrogate and the home had told them about the course and supported them in attending. The training plan for the home shows that staff training is up to date. Carers spoken with said that they had attended compulsory training earlier this year. There is a training officer who has attended courses to allow her to deliver the training at times that are convenient for staff. About a quarter of the carers have achieved a National Vocational Qualification Level 2 in Care and there are assessors employed at the home to support these individuals in their learning. People are more likely to receive safe, consistent care from staff who understand their role. Older People There were enough staff on the dementia unit to meet all the care needs of the people living there. The assessment, carried out by the inspector, showed that staff interacted very positively with the people who live on the unit and staff were very alert to them calling out or showing other behaviour that meant they needed assistance. In January 2007 it was reported that the staff are skilled and suitably qualified to do their work. Picture surveys, which are very easy to understand, were completed with help by a few of the people who live on there. They all said they were happy living there. A relative’s survey said the team was “professional and caring – never met a team who work so well together”. Another comment was “they go to considerable lengths to stimulate and interest.” On Ripley the levels are generally five staff on a morning, four on a late shift and two through the night. This is for 20 people. On the day of the visit there seemed to be enough staff on duty and carers had enough spare time to talk a little with the people who live there. One person said, “the staff are very nice. Yes I think they know what they are doing”. Staff spoken with said that they enjoyed their work and felt supported and valued. They also confirmed that they had attended induction training when they started work. Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 24 Younger Adults On Farnham unit, although the number of people living there is steadily increasing, there are still enough staff, with flexibility built into the rota, so that carers can attend social events with people at the home. Four more care staff are due to start work on this unit once their recruitment checks have been completed. Staff have the opportunity to attend a variety of specialist training related to the complex needs of some of the people there. Those staff spoken with in January had a good understanding of the needs of the people there. They also explained that they attended weekly team meetings where any issues about care needs could be discussed. Comments made on feedback forms include “there is no one I don’t like and I was looked after very well” and “… is very happy here indeed. They think the care is excellent.” “This feels like real life”. Thistle Hill Care Home DS0000069350.V343636.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.V343636.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: There have been a number of changes in senior management in recent months. One person said in their survey “the home needs to stabilise. There are too many changes going on at the moment”. The present manager has been at Thistle Hill for about two weeks. She is an experienced manager who previously worked at another Barchester home. She plans to apply to be registered with the Commission. She is aware of some of the challenges at the home and has already introduced some changes in the short time she has been there. Large numbers of staff changes recently have been mainly due to competition from other care services locally. The manager is addressing this by introducing a local pay structure and career pathway for care staff, so that Thistle Hill can remain competitive and hopefully retain its staff better. She has a good understanding of the very different needs of the people who live there. Staff spoken to feel that she is very approachable. One person living there said they had been introduced to her and she seemed “very nice”. She has held a ‘welcoming party’ for residents and relatives, where she has explained her priorities for the coming months. There is a quality monitoring system in place. Barchester produces questionnaires for residents, relatives and other health care professionals. The manager has also used her own surveys to find out what is important for the people who live there. The Younger Adults unit also keeps a record of comments made by people who spend time there. All these systems guide staff on what is working well and what areas need improving. There are monthly visits by a senior manager, employed by Barchester, who carries out a number of checks on how the home is run. The home also notifies the Commission of serious events potentially affecting residents. The way the home manages people’s personal monies was not inspected. In January 2007 it was noted that the home does not hold any money for people Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 27 living at the home and all bills are invoiced to their representative. Records were in order and paper receipts confirmed the transactions shown on the computer. These systems protect residents from financial abuse. Accident records are completed appropriately, stored securely and monitored. These can highlight recurring problems happening at the home, which can then be addressed. There are a range of health and safety policies and procedures in place. The home has made proper provision to ensure that there are safe working practices by providing staff training in first aid, fire, food hygiene, infection control and safe moving and handling techniques. There is a maintenance person employed at the home, and they carry out daily, weekly and monthly checks so as to maintain the safety of the premises. The health and safety records were generally in good order and fire safety checks are done regularly. Portable appliance tests, gas certificate and legionella water testing were checked. However prepared foodstuffs stored in the fridge were not dated so it was unclear when they must be thrown out. This poor practice, which could place people at risk of food poisoning, was discussed with the chef on duty and the manager. Hot water temperature checks are currently only monitored every three months. All hot water taps to which people living there have access should have the water temperature checked more frequently to reduce the risk of people getting scalded from water that is too hot. This was raised at the last inspection in January. Thistle Hill Care Home DS0000069350.V343636.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 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 2 29 2 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.V343636.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? New service 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 OP9 Regulation 12(2) Requirement A person’s GP must be informed if prescribed drugs are not available so alternative treatment can be prescribed, if necessary. The hot water temperatures of all taps to which people living at the home have access, should be monitored in such a way that the risk of people getting scalded is minimised. Timescale for action 17/07/07 2 OP38 13(3) 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations People who have repeated short stays at the home should have their care needs checked with them before each admission to confirm that their needs have not changed. It would be good practice for staff to count the non- blister packed tablets weekly to check they are being given DS0000069350.V343636.R01.S.doc Version 5.2 Page 30 2 OP9 Thistle Hill Care Home according to prescription. 3 4 OP10 When being seen by their doctor peoples’ bedroom doors should be kept shut to maintain privacy and respect. 50 of care staff should have achieved a National Vocational Qualification Level 2 in Care or equivalent by 2008. The manager should satisfy herself that recruitment records stored away from the home meet the legal requirements. All stored food should be labelled and dated to say when it needs to be discarded. OP28 5 OP29 6 OP38 Thistle Hill Care Home DS0000069350.V343636.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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.V343636.R01.S.doc Version 5.2 Page 32 - 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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