Inspection on 19/03/07 for Thornbank Residential Home

This inspection was carried out on 19th March 2007.

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 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

Thornbank Residential Home 18/12/07

Thornbank Residential Home 18/01/06

Thornbank Residential Home 11/05/05

Thornbank Residential Home 20/01/05

Thornbank Residential Home 22/09/04

Thornbank Residential Home 18/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Thornbank Residential Home 6 Westerfield Road Ipswich Suffolk IP4 2UJ Lead Inspector Jan Davies Unannounced Inspection 19th March 2007 13:30 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 Thornbank Residential Home DS0000024512.V328964.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. 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. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thornbank Residential Home Address 6 Westerfield Road Ipswich Suffolk IP4 2UJ 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) 01473 253346 01473 639218 thornbank@greensleeves.org.uk www@greensleeves.org.uk Greensleeves Homes Trust Mrs P O Hadden Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2006 Brief Description of the Service: Thornbank Residential Home is situated in a pleasant residential area of Ipswich and provides accommodation and care for up to 33 older people. The home is owned and administered by the Greensleeves Homes Trust, a non profit making organisation and looks out onto Christchurch Park. The home is sited within easy reach of Ipswich town centre with all its facilities and resources. The building has been registered as a care home since 1945 when it was first purchased by the WRVS. In 1995 the neighbouring property was acquired and an extension with a link between the two houses was built. Accommodation is sited on three floors but all are accessible via a passenger or stair lift. The home has 29 rooms for single occupancy and two shared rooms all of which benefit from ensuite facilities with a minimum of a washbasin and toilet. Twenty-eight rooms also have the advantage of an ensuite shower facility. Additionally the home has 5 assisted bathrooms, which are located across 3 floors. The home has three communal lounges, and a large dining room. One of the lounges is located on the first floor of the building and is often used for religious meetings or hairdressing services. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on Monday 20th March 2007 between the hours of 13: 30 and 16:40 the inspection was undertaken by regulatory inspector Jan Davies who was assisted in the process by the homes manager, residents and staff members. All staff spoken with at the home were friendly and provided information requested by the inspector promptly and openly. The inspector conducted a tour of the premises and spoke to residents who gave a very positive view of what it is like to be living in the home. Observation of work practice was undertaken during the inspection. Most service users were met and a number were spoken with about their experiences at Thornbank. The home is currently caring for 31 service users. Four staff members were met and spoken to about the home. Records were viewed during the inspection, which included care plans, medical and health records, training records, staff records and the home’s policies and procedures and related information. What the service does well: What has improved since the last inspection? This service continues to care sensitively for people who are elderly and who often are physically frail too. Dignity and choice are concepts that are apparent in the way staff interact with residents. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 6 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. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 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 Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 Quality in this outcome area is good. Prospective service users can expect that they will be provided with the information they need to make an informed choice about where to live, that they will have their needs assessed and met and that they will be provided with the opportunity to visit the home before they decide to move in. This judgement has been made using available evidence including a visit to this service. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 9 EVIDENCE: The home’s statement of purpose was appropriate in content and included all required information. The service users guide was in an accessible format, which included all required information including service users comments about the service. The statement of purpose and the service users guide both include contact details of CSCI. The home’s statement of purpose explains that prospective service users will be encouraged to visit the home prior to moving in where practical. Four service users’ records were viewed and each contained a written contract, an assessment of their needs, and care plans explaining how these needs will be met. Risk assessments were completed by senior staff or the home’s manager and were detailed and comprehensive. Staff training records were viewed, these evidence that staff are trained appropriately and have sufficient qualifications to meet the needs of service users. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is good. People who use this service can expect to have their care needs documented and met most of the time, but more consistent recording of medication will ensure quality of care for every resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans and associated records, such as the daily statements, relating to seven residents were examined. These were discussed with staff; the manager and two residents were spoken with about their own care plans. Each plan had several elements to the care plan including communication, being safe, personal care, dressing, eating and drinking, sleeping, mobility and recreation needs. All these care plans were clear and easily understood. There was evidence of monthly review and continuous assessment of risk. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 11 The residents’ files seen all had records of the resident’s GP and other health professionals such as the district nurse, chiropodist, optician and dentist There was evidence that residents’ weight is monitored for promoting good health and food charts are implemented if there is concern that a resident is not eating enough or has lost weight. Waterlow assessments for skin integrity were completed with the interventions required if the resident had a score indicating they could be at risk. Care plans seen also covered mobility, communication, personal hygiene, dental and foot care, nutrition, medication and social and religious activities. There was evidence that care plans were evaluated and reviewed regularly. Part of the risk assessments addressed some of the particular concerns related to caring for elderly people with specific vulnerabilities. The medication policy was seen and is satisfactory. The medication administration records (MAR sheets) were seen and each one had a recent photograph of the resident for identification. Two gaps were noted in the signature boxes. When a code was used a written explanation was recorded. There was evidence that the manager regularly undertakes an audit of the MAR sheets. It is recommended that the home review their monitoring. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. Service users can expect that their social, cultural, religious and recreational interests and needs are met and that they are helped to exercise choice and control over their lives. Service users can expect that they receive a wholesome and appealing balanced diet and that they maintain contact with others who are important to them. EVIDENCE: All the residents’ files seen contained details of their next of kin and contact information and social histories. Some of the life story work covered details of extended family members and their connection with the resident. Final wishes were also recorded. There was documented evidence of the activities each resident had been involved in. One resident had participated in a poetry reading and been out in the car with their relatives. Another had taken part in a quiz, a story telling session and reminiscent type games. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 13 Service user records viewed identified the significant others in the service users lives and the usual contact arrangements, records evidence when service users have maintained contact with others. At the time of the inspection there were no relatives visiting the home but service users confirmed to the inspector that their families and friends were made welcome in the home when they visited. The home has appropriate monitoring/vetting procedures in place and a visitors’ book to enhance security arrangements. The home has access to an independent advocacy agency which would be contacted should the need be identified. All service users spoken with said that the staff group were very good. Resident’s bedrooms were viewed during a tour of the building. All bedrooms contained service users individual belongings including memorabilia and photographs. Some service users bedrooms contained their own furniture, a member of staff confirmed that service users could bring their own furnishings to the home if they choose to and this was practical. Service users records viewed show service users likes and dislikes and what they enjoy doing, and a record of their activities is maintained. The inspector was also able to see photographs and information demonstrating that all involved were clearly enjoying this. Some service users are well enough and able to go out for walks if they want to and often go out with their families. The staff encourage residents to take part in and provide activities that everyone enjoys in addition to any professional entertainment arranged and two service users asked commented favourably about the activities co-ordinator. The menus provide three choices of the main lunchtime dish and two choices for supper. A member of the care staff consults with residents each afternoon to enable the residents to make their choice for the following day. Should a resident change their mind on the day an alternative would be provided. Two residents spoken with indicated to the inspector that they had enjoyed their meals. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. Residents can expect that their complaints will be listened to and that they will to be fully protected from abuse. The home has systems in place to ensure that all staff members are appropriately trained in protection of vulnerable adults and aware of all the risks of harm to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints received by the home or CSCI since the last inspection. Information from relatives indicated that they knew what to do if they were unhappy about something in the home, and said that they knew the manager would always listen to them and ‘do something about it’. The home has a policy for the protection of vulnerable adults and a whistleblowing policy. Staff spoken with had received training and were able to identify appropriate action to take in the event of an allegation being made. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 15 Staff were familiar with the home’s whistle blowing policy and aware of guidance on how to follow this if the need arose. It was noted that training is planned regularly for staff on protecting vulnerable adults and takes into consideration updating staff who have already received initial training. The home actively addresses the need for respecting each other and promotes anti-bullying attitudes. There was staff training information and evidence of discussion in staff meetings and residents’ meetings about this. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23,24,26 Quality in this outcome area is good. People who use this service can expect to live in a clean, safe home with specialised equipment available to maximise their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bathrooms are equipped with grab rails and bath and shower seats for service users safety and comfort. The home has storage space where wheelchairs are stored; there are sufficient hoists available. Service users were observed using walking frames in the home. All rooms are provided with call systems, including communal areas, bathrooms and bedrooms. All bathrooms are provided with hand wash gel and disposable towels. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 17 Service users bedrooms have appropriate furnishings and fittings, including lockable storage areas, bedroom doors have locks, which service users may use if they choose to. Doorways and corridors throughout the building were wide enough to accommodate wheelchairs. There were a number of hoists, handling belts and other aids to moving people safely in evidence around the home. There were rails up the stairs and the second floor stairs were protected with a small gate at the top. Some residents were using special recliner chairs and pressure relieving cushions and mattresses were seen. All staff receive training regarding the Control of Substances Hazardous to Health regulations (COSHH). All the cleaning products are kept in a cupboard that is locked. Hand washing facilities all have liquid soap and paper towels available and there were disposable gloves and aprons for meeting infection control policies. All visitors to the home are encouraged to use anti microbial foam on entering and leaving the building. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. Service users can expect that staff that are trained and competent to do their jobs supports them and service users are supported and protected by the homes recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff rota was discussed and showed that for 31 current residents there were sufficient carers per shift. However at times when care staff assist with meal preparation there are then less staff directly available to offer personal care assistance or provide a 2-1 if risk assessed as needed or if spontaneously required. Representation was made to the inspector from staff about this situation and it is recommended that staffing arrangements for ‘key’ times such as meals be reviewed. On the day of inspection there were no difficulties encountered but the home is planning for the return of a resident who has recently been hospitalised and consideration will need to be given about any change to dependency need and staffing ratio in the home. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 19 Staff training files were seen and showed that they had all had an induction on commencing in post that covered fire awareness, health and safety, infection control, moving and handling, food hygiene and first aid. There was evidence that there were updates of training at regular intervals. There were also additional subjects such as the ageing process, the use of restraint, the bereavement process, continence and pressure area care useful to staff development within this service. Since the last inspection training has continued on caring for people with dementia and vulnerabilities relating to POVA. There was documented evidence in the files and written work to back up the staffs’ understanding of the information. The personal files of a number of appointed staff since the last inspection were seen. They all contained satisfactory CRB checks and the proof of identity needed but one seen did not contain the required 2 written references. The manager said that she had positively sought these from previous employers, following telephone confirmation of good character and work performance, but written references were not available within the staff file. The homes own quality monitoring had recommended that staff files be made more clear and indexed for ease of access to categories. This had yet to be done. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 Quality in this outcome area is good. Service users can expect that the home is managed by a person who is fit to be in charge of the home and that their health and safety will be promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and most of the staff at Thornbank have received training in dementia care and the manager shows a clear knowledge of the service user group and has several years experience of working with people with needs relating to ageing. A number of staff were spoken with were very positive with regards to the management of the home and of the supportive staff group. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 21 In terms of safe working practices there was evidence at the last inspection that records on training for first aid, abuse, fire and manual handling were available and these were assessed as satisfactory. Residents’ files were sampled and reflected that there are appropriate arrangements made by residents and their families or appointed representatives to safeguard their financial interests. The home’s staff members are not appointees for residents’ money and are not authorised in this capacity. The home’s policy and procedures file reflects that staff have the appropriate information about this available to them and induction training information shows that this topic is covered when staff begin working in the home. Risk assessments were in place for individuals in relation to their needs and specifically for their safety in relation to accessing the environment. Health and safety documentation was available and evidenced that the home keeps up to date and appropriate records of maintenance. On the afternoon of the inspection the home was experiencing problems with the heating boiler, which affected the annex only. The problem has been intermittent over a three-week period, which required the contractors to visit the home on eight separate occasions. All the ten residents affected were given the option during the day of sitting in the lounges in the main house which were unaffected by the heating problem. The manager asked the residents affected what they preferred and if they choose to stay in their own room they were provided with blankets and also provided with additional bedding at night. During the inspection representation was made to the inspector about how the views of staff and residents are progressed. The home has very clear monitoring arrangements including visits in line with Regulation 26 on behalf of the organisation and reports seen of these visits were detailed. All the records were securely kept. Files were ordered and accessible. There was evidence that the health and safety of staff and residents is protected. Radiators had protective covers. Certificates for the checking and maintenance of the fire alarm system and equipment, were available and in date. The accident/incident records showed no serious episodes since the last inspection. Residents had sustained a number of falls and minor injuries such as skin tears or bruising that had been appropriately managed. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 22 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 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 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 3 X X 3 3 3 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 13(2) Requirement The Registered Persons must ensure that the medication administration record is completed for all medicine given. Timescale for action 01/05/07 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. Monthly OP27 Good Practice Recommendations The Registered Persons should ensure that the level of staffing provided at key times of day night is continually monitored to ensure that the individual needs of residents are adequately met during this period. Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Thornbank Residential Home DS0000024512.V328964.R01.S.doc Version 5.2 Page 25 - 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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