This inspection was carried out on 30th January 2006.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.
CARE HOMES FOR OLDER PEOPLE
Thistlegate House Axminster Road Charmouth Dorset DT6 6BY Lead Inspector
Marion Hurley Unannounced Inspection 30th January 2006 14:00 X10015.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 Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 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. 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. Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Thistlegate House Address Axminster Road Charmouth Dorset DT6 6BY 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) 01297 560569 01297 560569 Mr John A Corney Mrs June P Webb Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. One of the following rooms may be used as a double at any one time: 4, 15, 17, 27, 28, or 31 One named person (as known to CSCI) in the category DE(E) may be accommodated to receive care. 29th June 2005 Date of last inspection Brief Description of the Service: Thistlegate House is an elegant listed graded II building. It stands in four acres of grounds and gardens and commands exceptional views of the surrounding countryside. The house is situated near to the seaside village of Charmouth and is approximately two miles away from Lyme Regis coastal resort. Mr J Corney and Mrs J Webb have owned and managed the home since 1994. The accommodation comprises a total of 17 bedrooms, mainly singles, spread over two levels (upper and lower ground and first floor). It includes a large lounge and a dining room and five bathrooms plus additional WCs; one single and one double-sized bedroom have an en-suite WC facility. There is no passenger lift in the home. For service users with limited mobility access to first and lower floor bedrooms is achieved by the use of a stairmatic chair with staff assistance. The gardens and grounds are extensive and landscaped with flower borders, lawns, roses, mature shrubs and trees. The most recent feature to be developed is a kitchen garden. Attractive garden furniture and potted plants compliment the paved patio area directly outside the lounge, which provides a relaxing place for service users to sit safely outside. Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection has been undertaken as part of the normal inspection process legally required in accordance with the Care Standards Act 2000. Thistlegate House was assessed according to the Care Homes for Older People, National Minimum Standards. The inspection took place over ten hours four of which were spent in the home. During the course of the visit two members of staff were present and the registered providers were available. A total of five residents were spoken with. Records and documents relating to those standards assessed were examined and read. The inspector was grateful for the time and support provided by both residents and the members of staff available on the day of this inspection visit. Requirements and recommendations from the previous inspection were specifically assessed and the outcomes are recorded in the scoring and in the statutory requirements and recommendations noted at the back of this report. What the service does well:
Thistlegate House offers a comfortable and well-furnished home for residents. The home is attractively decorated throughout. The staff and Registered Providers work hard to maintain the relaxed and friendly environment. Thistlegate House has an established staff team many of whom have worked at the home for several years. Staff work hard and have developed good relationships with the residents and with each other. Throughout the inspection visit it was positive to overhear and observe the good-natured banter between residents and staff. It was also evident that staff consult and discuss with the residents with regard to their personal care ensuring the residents’ respect and dignity. Residents spoken with said that the “girls/staff are a good cheerful lot”. A relative had written describing the staff as providing “wonderful care and attention”. Admissions to the home are conducted in a planned way and the Registered Providers recently and successfully applied for a variation to the home’s conditions of registration to enable them to offer personal care to a resident with specific needs. The assessments and care plans reflected the time taken to ensure the person’s needs would/ could be met by the services and facilities at Thistlegate House. This has been a successful admission and the resident has settled in well. Meals are a highlight for many of the residents and the variety and quality of meals is extremely high. The Registered Providers base their menu on fresh seasonal food and access good local suppliers. Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 • • The home obtains pre-admission assessments enabling them to make an informed decision as to their ability to meet the needs of prospective residents. Standards 3 & 5 were assessed and met at the previous inspection and NMS 6 is not applicable at Thistlegate House. EVIDENCE: Since the last inspection one person has been admitted to Thistlegate. The records reflected the person’s needs and abilities. The care assessment and plan were well documented indicating how the persons’ needs would and are now being be met. The documentation has a section for comments and signature either by the resident or their representative and on this occasion the resident’s long standing friend / power of attorney had added their comments to the plan. Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 • The arrangements in the home to meet the resident’s medication needs are good and provide safe working practices EVIDENCE: The storage of the medicines and the medication records were all examined and found to be safely and well maintained. The storage system was clear and securely locked with an additional locked storage for controlled drugs when in use in the home. At the present time no resident is prescribed controlled drugs. Boots The Chemist who supplies the medicines to Thistlegate House complete regular audits of the storage and administration of medication and the last report completed by the Pharmacist in September 2005 stated, “ no action required”. No resident currently needs “ homely remedies” though a small supply of commercial products are available in the home. The residents’ GPs complete medication reviews regularly. Medication forms are completed if any resident is away from the home. These specify the amount and details of the medication leaving the home and are signed by the member of staff with the responsibility for the administration of medication on that day. This information is then checked and signed when the
Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 10 resident and their any medication returns to Thistlegate House. Details of each resident’s medication are included in their personal records along with their care assessments and plans. Predominantly one of the Registered providers( Mrs Webb) takes the responsibility for administering the medication however if they are not available one of the experienced care assistants takes this responsibility. The Providers and care staff have received basic training in the safe handling of mediation however it is recommended all staff complete an accredited refresher training course. Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 & 15 • • Residents are helped to make decisions and personal choices in all aspects of their daily lives. Meals in the home are both well presented and provide residents with a varied and interesting menu. A choice is always available for every meal. EVIDENCE: Thistlegate House employees a full time chef and with the Registered providers plan and prepare the menu according to the seasonal fresh food available. In addition the home has a productive kitchen garden, which supplies further seasonal vegetables. The Registered providers do all the shopping and resource good quality food from local suppliers. Each morning the residents are informed of the menu for the main meal and alternatives are always suggested if the resident wishes. The menu on the day of the inspection was homemade soup followed by cottage pie with celeriac topping and fresh vegetables. Both hot and cold desserts were available. Where required special dietary needs are catered for. A record of all food consumed is recorded in the mid-day menu diary and a separate record in the Supper diary was noted. At the present time five residents chose to enjoy their meals together in the dining room whilst the others have their meals in their bedrooms.
Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 12 Breakfast is served in the residents’ bedrooms and they may choose what they want to eat and drink for this meal from a full cooked meal to toast or cereals. Supper is always a cooked meal and residents are asked in the afternoon what they would like .A different dessert from the mid-day meal is available plus home made cakes. Residents were asked what they thought about the meals and of the three asked all unequivocally stated “very good, excellent, proper cooking” and one person identified the value of their meals “its important to have good meals”. Records maintained in the kitchen included the cleaning schedule and the temperatures of appliances however it is understood the chef had removed the most recent and it is important all the records remain in the home.( please reference NMS 38) West Dorset District Council, Community Protection Division inspected the kitchen and cellar on 16:01:06 and the report stated “ conditions generally good”. Two requirements and one recommendation were made one of which has already been addressed and the other two are in hand for completion. Those residents spoken with said they felt able to make their own decisions and therefore choices about several aspects of their daily lives at Thistlegate i.e., the time they choose to get up and go to bed, the choice at meal times, receiving visitors and whether they chose to join in social activities in the lounge. Some residents are less able to indicate their preferences and staff stated “ we do our best to make the right decisions on their behalf” though they acknowledged that sometimes it was difficult to encourage residents to socialise with the others even though their family and visitors might wish they would participate more. On the day of this visit three ladies were resting in the lounge after lunch and others were in their bedrooms. However at the start of supper more residents came to have their meal in the attractive dinning room. Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 were assessed and met at the previous inspection. EVIDENCE: Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): • Standards 19 & 26 were assessed at the previous inspection (July 2005) EVIDENCE: The new carpet required – NMS 19 and carried forward from a previous inspection has now been ordered and will be laid in stages throughout the home. An extremely good quality and attractive carpet has been selected and the opinions of the residents and staff have been sought in the process of making the final decisions. The first stage will involve the carpet being laid in the lounge and dining room followed by the downstairs corridor and then the final stage will be the upstairs corridor and staircases. Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 • Thistelgate House employs a sufficient number of staff some of whom have National Vocational Qualifications whilst others have many years work experience. EVIDENCE: During the course of this inspection visit both Registered Providers were available and two care assistants. The staff rota includes three care assistants working throughout the day in addition to the Registered Providers who are available and working in the home. Staff were observed working well together and there was good humour in addition to factual information being exchanged. Throughout the visit the home had a “ busy feel and was vibrant with much chatter and banter between staff and residents”. The residents spoken with confirmed these observations and the following comments were made with reference to the “girls” “ they’re a good bunch, they work hard but always have a laugh”. Both staff met at this inspection have worked at Thistlegate for several years and both commented that they continue to enjoy the work. The Registered providers have recently completed a training course in risk management and hope to cascade this information to all staff to increase their awareness of maintaining resident’ safety at all times. Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 35 • The Registered providers encourage continuous self-monitoring in addition to written questionnaires based on seeking the views of residents and key stakeholders. • All residents either manage their own money or have personally nominated a significant person of their choice to do so on their behalf EVIDENCE: The Registered Providers stated that they do not manage any of the resident’s financial affairs and no money is held on the resident’s behalf except for a limited number of the residents who have either personally or their representatives requested that their personal allowance is managed on their behalf. This money is used for minor expenditures i.e. hairdressing, chiropody. Each resident has their own “purse” and individual records were noted and are clearly maintained showing all transactions and the running balance. Receipts are kept of all transactions and a copy either provided to the resident or their representative. The monies are securely kept locked in a cabinet in the office.
Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 17 The Registered providers are in the home daily and they feel their presence ensures continual self-monitoring of both the residents’ needs and the staff performances and attitude. The Registered Providers have designed a questionnaire to be circulated to all the residents and relatives and other stakeholders to formally monitor the quality and success of meeting the needs of the residents and the aims and objectives of Thistlegate House. The registered providers must ensure that records verifying food hygiene, safe storage and preparation of food and the temperatures of appliances associated with these i.e. fridge & freezers are maintained and kept in the home. (please reference NMS 15) Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 18 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 x 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 x x x Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2) Requirement The Registered Providers must evidence that the Care Plans are written with each resident and provide the basis of care to be provided. Please note at the time of this inspection there remain only two care plans to be reviewed and written in the new format. The residents or their representative have signed those plans already completed. Risk assessments must be specific to the individual and regularly reviewed. Risk assessments must be completed in respect of all windows above ground floor. Please note the Environmental health office West Dorset District Council is advising on this matter. It is recommended the registered providers seek written confirmation from EHO with regard to this matter. The registered provider must ensure that records verifying
DS0000026880.V274403.R01.S.doc Timescale for action 31/03/06 2. 3. OP7 OP38 13(4) & 14(2) 13(4) 31/03/06 31/03/06 4 OP38 16(2)(g) (j) 31/03/06 Thistlegate House Version 5.1 Page 20 food hygiene, safe storage and preparation of food and the temperatures of appliances associated with these i.e. fridge & freezers are maintained and the records kept in the home 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 OP9 Good Practice Recommendations It is recommended that all staff administering and handling medication undertake a refresher training course in the safe handling of medication. This training course must be accredited. Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Thistlegate House DS0000026880.V274403.R01.S.doc Version 5.1 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
