Inspection on 01/12/05 for Thompson Court

This inspection was carried out on 1st December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Thompson Court 14/09/07

Thompson Court 14/09/06

Thompson Court 31/05/05

Thompson Court 02/02/05

Thompson Court 21/04/04

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Snydale Care Home

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Whiteley House

Larchfield Manor

Hawkhills

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The Grove Waltham

Staveley Birk Leas Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Thompson Court Morton Lane Crossflatts Bingley BD16 2EP Lead Inspector Ann Stoner Unannounced Inspection 1st December 2005 10:30 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 Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 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. Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Thompson Court Address Morton Lane Crossflatts Bingley BD16 2EP 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) 01274 561965 01274 563786 City of Bradford Metropolitan District Council Department of Social Services Mrs Miriam Dunn Care Home 37 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (37), Physical disability (8) Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The place for MD is specifically for the named service user. Date of last inspection 31st May 2005 Brief Description of the Service: Thompson Court is a Local Authority purpose built resource centre, situated in Crossflatts, very close to bus routes and adjacent to the main road to Keighley, Bingley and Skipton. The area surrounding the home is predominantly residential, with a school nearby and within easy walking distance of a railway station. It is a single storey building offering single room accommodation in one of four wings. Two wings offer bed-sitting type rooms, the others have sitting and dining areas. Twenty of the thirty seven bedrooms have en-suite facilities. The home provides personal and residential care for 1 service user who receives permanent care, 8 rehabilitation places, where the stay is usually no longer than 6 weeks, 2 step down places, with priority given to Airedale Hospital discharges, to accommodate people who would otherwise be classified as a delayed discharge in hospital, 2 social assessment places to reduce the need for crisis intervention at home, and 24 places for respite, rotational and short stay care. There is also a day centre with twenty places available from Monday to Friday. Day care services are not regulated. There are attractive gardens surrounding the home along with a small car park. Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was unannounced and took place on the 31st May 2005. There have been no further visits until this unannounced inspection. This inspection was carried out between the hours of 10.30am and 4.30pm. During the inspection, I looked at records, saw care staff carrying out their work, made a tour of some parts of the building and spoke with service users, staff, visitors and the manager. Comment cards/questionnaires are left for service users, visitors and other professionals at each inspection. These provide an opportunity for people to share their views of the home with the Commission for Social Care Inspection (CSCI). We discuss any comments received with the manager, without revealing the identity of those completing them. Eighteen have been returned from service users and fourteen from relatives. Copies of previous inspection reports are available via the Internet at www.csci.org.uk. What the service does well: What has improved since the last inspection? What they could do better: There are two main areas of concern, both of which have an impact on the management of the home and staff morale. The first is that the home does not carry out its own pre-admission assessment before service users are admitted which means that the dependency levels of the service user group at any one time can be greater than the ability and numbers of staff. Secondly the home offers a diverse service for people needing short stay, respite, rehabilitation, step down, social assessment and long stay, but the staffing levels are inappropriate for this type of service and the layout of the building. Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 6 The manager should delegate more of her responsibilities, refrain from carrying out personal care tasks, and be clear about the home’s admission criteria. Care plans must give clear instructions for staff, and risks must be properly identified with proper measures taken to make sure that service users are safe. Medication records must improve. All service users must be given a contract stating the terms and conditions of their stay. The home must keep recruitment records in the home. If an accident is not witnessed a record should be kept of when the person was last seen and by whom. The manager should keep a monthly breakdown of all accidents so that she can identify any trends or patterns and take preventative action. Financial statements must be given whenever a service user has money in savings accounts held by the Local Authority, and interest must be paid. Cleaning substances and toiletries must be stored in a secure place when not in use. A number of requirements and recommendations have been made to address these issues. These can be found at the end of this report. 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. Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 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 Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 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, 2 & 3. Written information about the home is now available for service users, but the lack of a written contract leaves relatives, and/or service users receiving short stay, respite or rehabilitation care, unaware of the specific rights and responsibilities of both the home and the service user. The home does not carry out it’s own pre-admission assessment therefore there is no guarantee that individual needs will be met taking into account other people with competing needs. EVIDENCE: The home now has a statement of purpose and service user guide, which gives service users information about the home. Both documents along with a copy of the complaints procedure and a booklet about Care Homes for Older People, published by the Commission for Social Care Inspection, are now available in each room. Contracts and terms and conditions are still not available for service users receiving short stay, respite, rehabilitation or assessment. Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 9 The home relies on assessment information supplied from an easy care document, completed by a social worker. The manager said that the information supplied in the easy care assessment is not always correct, and that the assessed person’s needs are not balanced against the competing needs of other people in the home. This would not occur if the home carried out a pre-admission assessment. Staff described situations where some service users are left unattended because of the needs of other people. Requirements and recommendations have been made to address these issues. Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 10 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): 7, 8 & 9. Care plans do not give clear instructions for staff and do not always identify risk. This provides the opportunity for needs to be overlooked and has the potential to place service users at risk. Although some recording errors were seen, overall medication practices have improved. EVIDENCE: Three care plans were sampled, one of which was in the new format recently introduced. All three plans failed to give staff clear and detailed instructions on the care they should give. According to the assessment information one person was admitted because of self-neglect, but his care plan stated that he needed no assistance to wash or dress. Daily records indicated that assistance was in fact required and was given. This person also suffered from depression, but there was little information for staff on how to manage this. From his daily records it was clear that one member of staff was trying to encourage him to complete some domestic tasks, but because this was not part of his plan of care there was no guarantee that other staff would follow a similar approach. This service user had sustained two falls during his stay, there was no comprehensive falls risk assessment completed, no care plan on the prevention of falls, and bed rails had been fitted, without any formal assessment of the Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 11 risks involved. One service user had been out in a taxi unaccompanied by staff, and had a kettle in her room so that she could make a drink as and when she wanted. There were no risk assessments in place. One person’s plan stated that she had poor hearing, but there were no instructions for staff on how to communicate with her. This person’s plan was dated March 2005, and had not been reviewed. When speaking to her it was clear that there were significant changes to her cultural and religious plan as she is now a practising Jehovah’s Witness. Staff were unaware of this. Handwritten entries on Medication Administration Records (MAR) are now checked and countersigned by a second person. Pharmacy labels specify that medication should be given twice a day, three times or four times a day, but when transferring this information onto the MAR staff use Latin terms such as bd, tds and qds. Some entries on one person’s MAR were not filled in, and staff did not know whether the medication had been given or not. One person was self-medicating but there was no risk assessment in place identifying how the home had assessed the risk of this person being able to self medicate. Requirements have been made to address these issues. Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 12 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): These standards were not assessed at this visit. EVIDENCE: Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 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): These standards were not assessed at this visit. EVIDENCE: Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 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): These standards were not assessed at this visit. EVIDENCE: Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 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): 27, 28 & 29. The staffing levels are inadequate for the service the home provides. Recruitment is thorough and protects service users, but not all of the required records are held within the home. EVIDENCE: From discussions with staff it was clear that morale is low, and staff feel under pressure. Staff said that in addition to providing personal care to service users; they serve meals, wash up in the kitchenettes after meals, carry out laundry and cleaning tasks, and have to complete care plans and reviews for the large number of service users who use the service. Because the home does not carry out its own pre-admission assessment, dependency levels of service users can vary enormously, and at times some service users are left unattended whilst staff assist other people. One member of staff said that she felt she could not cope anymore, and another said she never had any time to talk to service users. At the time of this inspection three service users were prescribed morphine, and the community nursing team were carrying out their own audit to identify the amount of time they spend providing a service in the home. The week before this inspection the home used 15 agency staff, which places additional pressure on existing staff. One comment card returned from a relative said, “Too many casual staff are a cause for concern.” Another said, “More staff would be appreciated by clients”. During the inspection one service user and her daughter spoke highly about the home, but spoke about the shortage of staff saying that the, ‘girls are always running.’ 50 of care staff have completed an NVQ (National Vocational Qualification). Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 16 The manager described how recruitment follows safe practices, but the required recruitment records for staff are still not held within the home. Requirements have been made to address these issues. Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 17 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): 31, 32, 33, 35, 36 & 38. The management approach does not support staff and they are not properly supervised. Residents are consulted but the financial interests of service users are not always safeguarded. The availability of cleaning substances and toiletries in communal areas poses a potential risk to service users. EVIDENCE: The registered manager has many years of experience, but due to changes and vacancies in the management team, she carries out management tasks that could or should, be delegated. She also said that due to the staffing levels in the home at times she has to carry out personal care duties and works over and above her contracted hours. This has an impact on the management of the home. Staff morale is low, some staff said that they feel that the home is Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 18 disorganised and others said that no action is taken on agreed decisions. There is still no formal system of supervision firmly established in the home. One person said she had not had a supervision session for over 3 years, another person, in post for over 6 months, had her first supervision session three weeks ago. There are a number of quality measures in place. These include an annual visit by a peer, followed by a report and visits completed under regulation 26 of the Care Homes Regulations. The manager said she has sent out 150 letters to carers inviting them to attend carer’s meetings twice a year. Satisfaction questionnaires are being developed. Residents meetings are held twice a year and minutes are taken Apart from one long stay service user; most finances are mainly handed over for safekeeping for the duration of the person’s stay. A receipting system is used for this purpose. The long stay service user has up to £500 held with Bradford social services; no interest is paid on this amount. This does not comply with the regulations or guidance published by the Commission for Social Care Inspection. An individual statement identifying transactions and balance has not been issued. A member of staff had bought duty free cigarettes for this service user, no receipts were available, and an amount of £120 had been handed over from monies held on behalf of the service user. This practice leaves the service user subject to financial abuse. Cleaning materials such as Cif cream and Titan Sanitizer were on the worktops in two of the wings, and toiletries were on the side of the bath on one unit. Cutlery and crockery are washed and rinsed by care staff in the kitchenettes on individual wings, instead of using the dishwasher in the main kitchen. Accidents forms were completed for one service user who had two falls during his stay. Staff had not witnessed these accidents and had failed to make a record of when the person was last seen and by whom. The manager keeps a running total of accidents in the home, but does not carry out a monthly analysis to identify any patterns or trends. She said that 50 of accidents took place on the rehabilitation wing, but without an analysis there is no way of identifying the dependency levels of service users or the numbers and whereabouts of staff on duty at the time the accidents occurred. Requirements and recommendations have been made to address these issues. Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 19 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 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X 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 1 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 2 1 X 2 Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 20 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 OP2 Regulation 5 (3) Requirement All service users must be provided with a contract specifying the arrangements made. This is outstanding from 2nd February 2005 and 31st May 2005. All service users must have a plan that sets out in detail the action which needs to be taken by staff to make sure that all aspects of the health, personal and social care needs of the service user are met. For service users staying at the home for longer than a period of one month, the care plan must be reviewed at least once a month. For other service users care plans must be updated on each visit and must be formally reviewed every third stay. This is outstanding from 31.5.05. All areas of service user risk must be identified, and a risk assessment completed. DS0000033518.V268105.R01.S.doc Timescale for action 31/03/06 2 OP7 15 31/01/06 3 OP7OP8 13 (4) (b) 31/01/06 Thompson Court Version 5.0 Page 21 4 OP7 13 (4) (b) Falls risk assessments must be completed and updated as necessary. This is outstanding from 31.5.05. Medication records must be completed each time a medicine is administered. Staff must not use Latin terms on medication records. An assessment must be completed for all service users who wish to self-medicate. This assessment must take into account their cognitive ability and capacity to manage their own medication. This is outstanding from 31.5.05. The home must make sure that at all times persons are working at the home in such numbers as are appropriate for the health and welfare of service users. This is outstanding from 31.5.05. Records of recruitment for all staff must be available in the home. This is outstanding from 31.5.05. The registered provider must demonstrate how each individual service user will receive any interest applicable to their individual savings. An audit trail must be available within the home for any purchases made on behalf of service users. Formal documented supervision of care staff must be DS0000033518.V268105.R01.S.doc 31/01/06 5 OP9 13 (2) 01/01/06 6 OP27 18 (1) (a) 31/01/06 7 OP29 19 31/01/06 8 OP35 20 31/03/06 9 OP35 13 (6) 02/12/05 10 OP36 18 01/01/06 Page 22 Thompson Court Version 5.0 implemented and take place at the required intervals. This is outstanding from 31.5.05. Used cutlery and crockery should be returned to the main kitchen and washed and rinsed in a dishwasher. When not in use cleaning materials and toiletries must be stored in a secure place. This is outstanding from 31.5.05. 11 OP38 13 (3) 01/01/05 12 OP38 13 (4) (a) 02/12/05 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 The home should carry out an assessment of need on all service users prior to their initial stay. This is outstanding from 31st May 2005. If an accident is not witnessed, records should show when the person was last seen and by whom. The manager should complete a monthly analysis that takes into account where and when accidents occur so that any patterns or trends can be identified. 2 OP38 Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Thompson Court DS0000033518.V268105.R01.S.doc Version 5.0 Page 24 - 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!