Inspection on 15/08/06 for Thornbury Care Centre

This inspection was carried out on 15th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Thornbury Care Centre 28/05/09

Thornbury Care Centre 09/11/07

Thornbury Care Centre 26/02/07

Thornbury Care Centre 30/11/05

Thornbury Care Centre 28/06/05

Thornbury Care Centre 23/03/05

Similar services:

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

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

CARE HOMES FOR OLDER PEOPLE Thornbury Care Centre 58 Thorndale Road Thorney Close Sunderland SR3 4JG Lead Inspector Miss Nic Shaw Key Unannounced Inspection 9:30 14 & 15th August 2006 th 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 Thornbury Care Centre DS0000063778.V298052.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. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thornbury Care Centre Address 58 Thorndale Road Thorney Close Sunderland SR3 4JG 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) 0191 5201881 European Care (England) Ltd Mrs Lynn Mason Care Home 44 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (23), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (6), Old age, not falling within any other category (21), Physical disability (2), Physical disability over 65 years of age (8), Sensory Impairment over 65 years of age (6) Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2005 Brief Description of the Service: Thornbury Care Centre is a three story building situated in the centre of Thorney Close. The home is registered for up to 44 people, 23 of whom have a dementia type illness. Nursing care is not provided but District Nursing services are accessed as required. The home is built on a sloping sight with accommodation for residents over two floors with a service area on the lower ground floor. Accommodation consists of a lounge and dining room and bathroom on each floor. A passenger lift serves the first floor, which specifically provides accommodation for people with dementia care needs. All bedrooms are single occupancy and each benefits from en-suite shower and WC facilities. The home has been specifically designed to provide accommodation for people who have a physical disability. There is a spacious garden to the rear of the home and a car parking facility is provided adjacent to the home. The home is situated close to local shops, pubs, places of worship and a community centre. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over two days in August 2006 by two inspectors and was an unannounced key inspection. The inspection included information which had been provided by the manager in a pre-inspection questionnaire some time before the inspection visit. However, since this information was submitted to the Commission there have been significant staffing and management changes within the home. This has involved the registered manager being suspended from duty as well as a number of staff being dismissed. As an interim measure a registered manager from another registered service within the organisation is currently responsible for the day to day management of Thornbury Care Centre. The company’s area manager also has daily contact with this service. Both managers were present during the inspection. As a result of these significant developments within the home the inspection focused upon the impact this has had upon the service users. A meal was taken with the service users on each floor of the home and a sample of staff and service user records were viewed. The inspection particularly focussed on four service users with very different needs and looked at what it was like, from their point of view, living in Thornbury Care Centre. This involved talking with those service users and some of their relatives, observing staff’s care practices with them and checking that information obtained from discussion and observation was accurately recorded in the care records. The fees payable range from £346.00 to £425.00. What the service does well: The area manager is working hard to address the poor standards within the home and there is currently lots of help from the manager’s and staff of other European Care homes so that this can be sorted out quickly. Those people who are independent are able to follow their preferred daily routines. One service user enjoys a daily walk and another service user said that she often spends the weekend at her relatives home. There are no restrictions on visiting time and the majority of service users said that the food was good. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 6 Staff on duty were observed to be courteous and friendly and despite the current staffing and other difficulties within the home service users said: “I like living here” “the girls are friendly” “some staff have a nice smile” “I feel safe here” “the foods OK” “the staff are very good”. What has improved since the last inspection? What they could do better: The registered manager has not always made sure that she obtains a full assessment from the social worker prior to a service user moving into the home. This means that neither she nor the service user can know whether or not the home is able to meet their needs. Some of the service users said that they felt that there are a number of people living in the home who are “wrongly” placed. Despite the manager being asked to look at this during previous inspections this has not been carried out. Care plans are very poor and in some there was no information at all available to tell staff what they should do to meet the service users personal care needs. The medication administration procedures are unsafe and this means that some service users are not receiving their prescribed medicines. Staff practices do not always ensure that the service users privacy and dignity is upheld. For example, the staff keep the bedroom doors locked on the first floor of the home where the people with dementia live. This means that people cannot freely use their private areas and are dependent upon staff or their relatives who have the keys to open them. There is very little for people to do in the home and many of the people with dementia are left sleeping in the lounges. Mealtimes are not relaxed for those people with dementia and the manager needs to look at how this can be improved to make this a pleasant occasion for everyone. The complaints procedure needs to be in larger print and placed at eye level, not high up on doors, so that it can easily be seen. When people have complained this has not been properly looked into and one relative said that they had lost confidence in the home’s procedure. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 7 The staff working with people with dementia have not had training in verbal or physical aggression. It was not known how many of the staff have completed prevention of abuse training and some of the staff said that they had not had this training. The manager needs to sort this out to ensure that everyone is protected from abuse. The building is not clean, for example some of the communal carpets were very dirty. A cleaning and maintenance programme needs to be put in place to put this right. It’s very noisy upstairs where people with dementia live. This needs to be looked at by the manager as this level of noise can lead to people with dementia becoming agitated. The layout of the bathrooms also needs looking at as staff say there is not enough space to safely use the bath hoist. Staff need training in infection control so that they know what to do to prevent cross infection. There are not enough experienced trained staff on duty so service users cannot be assured that there needs can be met. Staff recruitment procedures need to improve to make sure that only suitable people are employed to work in the home. The current manager needs to make sure that the staff are properly supervised and trained to make sure that the health and safety of the service users is promoted at all times. She also needs to make sure that she gets feedback from the service users about the home and use this information to improve the service. Hazards to the health and safety of the service users need to be identified by the manager and action taken to remove these. Service users said “things have been going wrong for a while” “there are lots of strangers in the office” “its been very upsetting for weeks” “little bits keep going missing” “I like living here” “the girls are friendly” “some staff have a nice smile” “I feel safe here” “the foods OK” “the staff are very good” Relatives said “I am appalled by the standard of cleanliness” “there have been no staff on and I have had to take people to the toilet” Staff said “there are not enough of us on duty”. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 8 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. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 9 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 Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 10 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): 3&4 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The admissions process does not ensure that service users are adequately assessed prior to care being offered and some of the service users who are accommodated on the ground floor still need to be re-assessed. This means that the service users living within Thornbury Care Centre cannot be assured that their care needs are being effectively met. EVIDENCE: Of those people chosen to “casetrack in some cases there was no full comprehensive social work assessment information available, only a brief “care plan” document. This alone provides very little information upon which the manager could make a judgement as to whether the home was able to adequately meet those service users health and personal care needs. There was no evidence available in the case files examined to show that the manager had carried out her own assessment prior to offering a prospective service user a place within the home. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 11 Some of the service users spoken to expressed their concerns at there being a number of people accommodated on the ground floor who have a dementia type illness. During previous inspections it has been a requirement for the manager to carry out a re-assessment of the service users needs to ensure that people are placed within the correct categories for which the home is registered. This issue has still not been addressed and remains a requirement. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 12 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&10 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Care plans are of a very poor and the quality of information has deteriorated since the last inspection. This means that the service user’s health and personal care needs are not fully met. Medication administered procedures and practices are unsafe and do not protect the service users health and welfare. Improvements need to be made to ensure that for those people with dementia their right to privacy and dignity is preserved. EVIDENCE: In all, bar one care plan, examined there was no information at all to guide staff on the action they need to take to meet the health and personal care needs of the service user. In one care plan examined a nutritional assessment had been carried out, dated, 9.6.04, which indicated that this person was at medium risk of malnutrition, yet other than their weight being measured on 11.8.04 no care plans were available to ensure that their needs in this area were being effectively met. One relative spoken to expressed concern that Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 13 their family member was not receiving the support that they needed with their personal care needs and was not helped by the staff to wash or bathe, saying “the flannel is always dry and there is no evidence that the towels are used”. There was no information in this person’s care plan to inform staff of the support they need in relation to their personal care, nor were there any records to show whether or not they had been supported to bathe or wash regularly. There was no information to guide staff on how to meet the complex, diverse needs of people who have dementia. The company has a standardised care plan format, yet many of these standard documents, if they had been placed in the case file, had been left blank. In some case files the documentation was a mixture of old and new with no sense of order. As such it was not possible to determine from the records whether the service users were receiving appropriate medical interventions such as chiropody, eye and ear checks, although one visitor spoken to said that her relative had recently “had her eyes checked” and in the past had attended chiropody appointments but said that they thought the next appointment was now overdue. The manager and area manager agreed that the care plans were in a poor state and during the inspection visit were in the process of arranging for managers of other home’s within the company to address this issue as a matter of priority. The medication storage and administration procedures were discussed with the person responsible for giving the medication on the day of the inspection. This staff member confirmed that they had in the past completed training on the safe handling of medicines. However, they said that they did not know what all of the prescribed medicines were for. There is not British National formula (BNF) which staff could use as a guide. A monitored dosage system is used, whereby the dispensing pharmacist supplies each service user’s medication within a sealed “blister” pack. A brief audit of the medicines was carried out which identified a number of serious concerns. One service user, who has dementia, had been prescribed an “as and when” medication to help with their agitation. During the inspection this service user was observed to be very agitated but when asked about this medication the staff responsible for the medication did not know where this was kept, and were uncertain as to whether or not this medication had been discontinued. On a later examination of the controlled drugs cabinet this medication was found. A supply of another medication was both in a bottle stored in the controlled drugs cabinet and also in the sealed blister pack in the medication trolley. The controlled drugs register indicated that there should be 4 temazepam for one service user held in stock, yet none could be found. Staff said that one service user regularly refuses their prescribed medication as it “makes them retch”, yet there was no evidence that a medication review had been carried out to address this issue. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 14 Despite the issue of staff not touching medication by hand, as this may lead to contamination, discussion with the staff confirmed that they handle the medicines when they carry out medication audits. The above as well as other issues relating to the medication were discussed with the current manager and area manager who had already identified this as an area of serious concern. In order to address these issues the manager was in the process of arranging for a pharmacist to provide additional training to all staff. An immediate requirement notice was issued to the manager in relation to the medication and care records. Staff spoken to knew what the service users preferred to be called and made sure that they addressed people in this way. However, current staff practices are institutional and do not support the principle of dignity and privacy. For example: the public telephone is left in a service user’s bedroom so that staff can easily access this when it rings. All bedroom doors are kept locked on the first floor of the home where people with dementia are accommodated. This means that people with dementia are denied access to their own private space and are dependent upon staff or their relatives who hold the keys, to open them. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 15 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): 12,13,14&15 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. There are limited opportunities for service users to take part in activities and occupation and maintain contact with the local community. This means that their right to lead an active, fulfilling, stimulating lifestyle is at risk. Service users are able to maintain family and other contacts to a good degree should they wish. This can help ensure they do not become socially isolated. Service users are not actively encouraged by staff to a good degree in exercising choice and control over their lives. This limits their independence. Residents receive an adequate menu. However, improvements need to be made to the mealtime arrangements in order to promote the service users general health and wellbeing. EVIDENCE: Service users said that there was little for them to do in the home. During the inspection visit people with dementia were found sleeping in lounges or “wandering” the corridors with little staff interaction and no stimulation. There is no activities programme and one service user said that there had only been Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 16 five games of bingo in the last two years and the last time they had a fayre was last summer. There have been no opportunities for service users to take part in day trips. Some of the service users, who are able, said that they visited the local church and shops and regularly went out for walks in the local community. However, those people who are dependent upon staff for support are not afforded with the same opportunities. There was no evidence to indicate that local community groups have any contact with the home despite the home being situated opposite the local community centre. People with dementia are located on the first floor of the home and do not have independent safe access to outdoor space and fresh air. Visitors regularly call to the home, and observations confirmed that that they could visit their relatives in private. Service users are able to bring personal possessions with them to the home. It was clear that those service users who are able, continue their own preferred daily routines and to make their own choices about how they spend their day, however, as mentioned earlier the people with dementia living in the home are not able to exercise choice and independently access their bedrooms or the garden. Service users were generally complimentary about the quality and quantity of the meals. Meals are served in the dining room by the catering staff from a hot lock trolley. A meal was shared with the service users on each floor of the home. For those people living on the ground floor of the home this was a relaxed social occasion, however, a number of the service users commented on the number of flies present in the dining area. For those people with dementia on the first floor of the home the opposite was the case. One service user became very agitated as the meal was being served and kept getting up to leave the dining area. It was evident that this was very disruptive to other service users and staff whilst they attempted to serve the meal. However, once this service user was served their meal they appeared more settled and quietly sat down and ate their meal. The staff confirmed that it was usual for this service user to become calm once given their meal. This was discussed with the manager who agreed that it would be beneficial for everyone for this person to be served their meal first. Service users were verbally offered a choice of main meal and when asked some said that they wanted the pasty. However, a number of the service users appeared to have difficulty cutting into this and some people left this on their plate. There was no salt or pepper on the tables and staff “stood over” one service user when offering them assistance with their meal. The experience of having a meal with people on the first floor of the home was not a relaxed occasion. One service user spoken to said that they were not consulted on the meals provided and that although there is always plenty of food the bread is never buttered. A relative also spoken confirmed this. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 17 . Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 18 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): 16&18 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. There is a complaints procedure, however, this is not easily accessible to everyone which may prevent some people from making a complaint. Complaints are not handled appropriately and therefore service users and relatives are not confident that their views will be listened to. Policies and procedures and staff training do not ensure the protection of the service users. EVIDENCE: There is a complaints procedure available in the home and this is displayed high up in small print on the doors of en-suite WC facilities. One relative spoken to said that she had lost faith in the complaints procedure as she had complained a number of times to the manager but nothing had been done. Discussion with the area manager confirmed that the registered manager had prepared a written response to this particular complainant, however, the current manager confirmed that she had recently found this in a drawer as it had not been posted out. There was no evidence available to show that a record of previous complaints made had been properly investigated. Records confirmed that some of the senior staff have had training on the prevention of abuse, however, there is no training matrix available to confirm whether or not all of the staff have completed this training. Two of the three staff working on the first floor of the home have had no previous experience of Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 19 working with people with dementia nor had they completed any training in this area, including how to deal with challenging behaviour and physical and verbal aggression. Two staff, who had been working in the home for some time, said that they had not completed training in the protection of vulnerable adults. Concern was expressed by one service user in relation to the attitude of one member of staff and this was discussed with the manager for further investigation. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 20 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): 19,20,26 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home does not offer service users with a homely, clean, safe, place in which to live. EVIDENCE: The overall impression of the home is one of neglect. Within the grounds, by the steps leading to the entrance to the home there is a build up of rubbish. There is a garden to the rear of the home, with a seated area for service users to use during warmer weather. However, the grass had not been cut for some time. At the entrance to the home there are a number of pots but the plants in these had died. On entering the home the carpets in some communal areas were filthy, particularly those in the corridor and dining room of the first floor. Carpets in some of the service users bedrooms were also soiled. Within a lounge in the first floor of the home there was a shelf missing from the bookcase and a second television lying on the floor. The corridors were bare in appearance and although there are some signs to help people with dementia Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 21 find their way, such as a knife and fork outside the dining room, small pictures of service users as they are now had been placed high upon some bedroom doors and the appropriateness of this, given that people living here have short term memory loss, was discussed with the manager. A negative aspect of the environment is the call system. Each time this is activated by a service user, or member of staff, the noise resounds throughout the home. During the visit the call system was activated regularly throughout the day which meant that service users are constantly subjected to this noise. This type of noise can have a negative impact on the comfort of the service users, particularly for those people with dementia and may make people irritable and result in “challenging” behaviour. A radiator in one corridor was very hot to the touch and a potential hazard should a service user fall against this. There was an unexplained noise coming from the loft area of the home, which the staff said they had reported but at the time of the visit no action had been taken in relation to this. (On the day of the second visit two maintenance people were in attendance and confirmed that hot radiator and unexplained noise had been addressed). There are two communal bathrooms, (one on each floor), so that service users who choose to can have a bath. However, the layout of the bathrooms means that there is not much room for staff or service users to use the chair hoist. This has been raised during previous inspections and has still not been addressed. There has been a recent environmental health visitor to the home and reported the main kitchen to be satisfactory. However, relatives spoken to expressed their concern at the standard of cleanliness within the small kitchenettes saying that often the home’s cats jumped on the kitchen benches as well as food being left uncovered here. During previous inspections it has been a requirement for the manager to consult with service users and their relatives with a view to establishing a smoking policy within the home. Although on this visit there was no evidence that people used the communal lounge as a smoking area, which was the case during previous inspections, service users said that some people continue to smoke in the communal dining area. Some service users are able to smoke in their bedrooms, however, there has been no fire risk assessment carried out to demonstrate that this is considered an acceptable risk. The laundry is located in the basement. The corridors in the basement area had not been swept and rubbish and disguarded cigarette ends were found here. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 22 Throughout the inspection staff demonstrated an awareness of infection control by wearing protective gloves and aprons, however, staff records examined indicated that staff had not completed training in relation to this issue. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 23 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&30 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Staffing levels are inadequate and a potential risk to the health and safety of the service users. Staff are not properly trained and sufficiently experienced to ensure that service users are in safe hands at all times. Service users are not protected by the home’s recruitment procedures. EVIDENCE: Time was spent observing staff practices and talking to service users on both floors of the home. On the first floor, where people with dementia are accommodated, there were three staff on duty, one of whom was the designated senior. Records examined confirmed that one staff member had only been working in the home since June 2006 whilst another since the end of July 2006. Discussion with them confirmed that they had had no prior experience of working in care or working with people with dementia. Neither of them had undertaken any training in health and safety matters, such as moving and handling, which was evident during observations of moving and handling techniques carried out by them. The senior member of staff, who was in charge, also said that she had not had any training in dementia care. Observations of the needs of the people indicated that current staffing levels are insufficient. For example: on arrival to the first floor of the home a large Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 24 potted plant had been knocked over and was lying across the corridor, a potential trip hazard. Staff were busy elsewhere in the building and had not noticed this. During the morning one service user had been given a cup of tea by the staff. The lounge was then left unsupervised and the service user spilt their tea. It was necessary for the inspector to alert staff of this accident as again they were busy elsewhere in the home. During lunch three people chose to have their meals in their rooms, some of whom require assistance with this. However, as there are only three staff on duty it was evident that people’s needs could not be adequately met. During lunch one service user began to choke. Although the staff in the dining room dealt with this as best they could by helping the service user to leave this area, later discussion with them confirmed that they had not had training in first aid neither did they know who the trained first aider was on duty. The area manager agreed that as a result of recent events in the home and subsequent staffing difficulties she had identified this was an area of serious concern and as an interim measure agency staff as well as staff from other European Care home’s were being used to maintain minimum staffing levels. However, as a result of observations during the inspection an immediate requirement notice was issued to the manager to carry out an urgent review of current staffing levels including the skill mix and experience, to ensure suitable competent, trained staff are on duty at all times. It was not possible to establish from records the percentage of staff who have completed NVQ level 2 training in care. Discussion with the area manager confirmed that it is the policy of European care to operate a thorough recruitment procedure. However, records examined were incomplete and did not provide the evidence to support this. For example: in one staff file a reference from the last employer had not been sought, there was no evidence to show that convictions disclosed had been discussed with the prospective employee or that gaps in the employment history had been explored. Records also indicated that senior staff had been responsible for carrying out staff interviews and recruiting staff, although the area manager confirmed that this was not company policy. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 25 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): 31,33,36&38 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service users have not benefited from a well managed home. Staff have not been appropriately supervised, the views of service users have not been sought and internal quality assurance systems do not demonstrate a commitment to continuous service development. However, immediate steps have been taken by the company to address these issue. Staff training does not protect and promote the health, safety and welfare of the service users. EVIDENCE: Due to a number of issues and concerns identified by the area manager during internal investigations, and as a result of her monthly visits and subsequent reports to the Commission under Regulation 26 of the Care Home’s Regulations Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 26 2001, the home’s current registered manager has been suspended. Discussion with the area manager confirmed that as an interim measure, and in order to address the large number of serious concerns, an experienced registered manager from another service being transferred to Thornbury Care Centre to manage the day to day running of the home. Senior staff from other European Care registered care home’s have been brought to the home to provide additional support. Although staff were aware of the suspension of the registered manager, service users and relatives at the time of the inspection had not been fully informed of what was happening in the home. Some service users spoken to said that staff had told them what was happening but that they would prefer to hear this from the current management first hand. These concerns were raised with the manager and area manager who agreed that it would be beneficial to hold a relative/service user meeting, which has since taken place. Records confirmed that staff had not received regular supervision and, as mentioned earlier in the report, some of them have not been provided with upto-date training in relation to first aid, moving and handling and fire safety. European Care as an organisation operates a thorough quality assurance system which involves seeking the views of service users as well as internal monthly audits of the quality of the service. However, the area manager confirmed that this had not been implemented within this home. An audit of service users personal allowance records was not undertaken during this inspection as the company have already identified this as an area of concern. The area manager is currently in the process of completing a full audit in relation to this and has agreed to inform the Commission of the outcome of this. This standard will be assessed during the next inspection. An entry had been made in the fire log book stating that the fire brigade had been called as a result of a piece of paper being left on top of a hot lock trolley. Neither the area manager nor the Commission had been informed of this incident and there was no evidence to indicate that a risk assessment had been carried out to prevent a re-occurrence. One service user said that they were concerned as another service users living on the ground floor, who liked to smoke, was often seen “wandering” around downstairs with their cigarette alight. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 27 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 X X 1 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X 2 X X X X 2 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X 1 X 1 Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14(1)(a) Requirement The manager must ensure that suitably qualified or trained staff have assessed the needs of service users before they are offered accommodation within the home. The manager must ensure that the number of people with dementia care needs is within the homes registered categories, and that the residents increase in dependency levels is kept under review.(Timescale not met 31/03/06). Service users care plans must be available and in sufficient detail to guide staff of the action they should take to meet their health and welfare needs.(Timescale not met 31/03/06). a) A full audit of all medication must be carried out to address the issues identified in this report and discussed during the inspection visit. b) Immediate action must be DS0000063778.V298052.R01.S.doc Timescale for action 31/10/06 2. OP4 14(2) 31/10/06 3. OP7 15 15/08/06 4. OP9 13(2) 15/08/06 Thornbury Care Centre Version 5.2 Page 29 5. OP10 12(4)(a) 6. OP12 16 taken to ensure that all service users get the medication for which they have been prescribed. c) Medication must not be handled by hand. The manager must ensure that staff practices respect the privacy and dignity of service users at all times. A range of activities must be offered to service users and these should be advertised for service users’ information. (Timescale not met 31/03/06). Opportunities must be provided for those people with dementia to maintain contact with the local community. All service users must have access to their own bedrooms unless it can be demonstrated through a risk assessment of individual needs that it would be an unreasonable risk for them to do so. (Timescale not met 31/03/06). The complaints procedure must be made accessible to all service users and be available in a format suitable to those people who have a visual disability. A record of all complaints made must be held in the home, to include the action taken by the registered person in response to the complaint. a)All staff must receive training in relation to the prevention of abuse. b)All staff working with people with dementia must receive training in relation to physical and verbal aggression so that this is understood and responded to appropriately. DS0000063778.V298052.R01.S.doc 31/10/06 31/10/06 7. OP13 16(m) 31/10/06 8. OP14 12(4)a, 13(4)a 31/10/06 9. OP16 22(6) 17(2) 31/10/06 10. OP18 13(6) 31/10/06 Thornbury Care Centre Version 5.2 Page 30 11 OP19 OP26 23 12 13 OP19 OP19 13(4)( c ) 12(2),12( 3)&13(4) ( c ) The manager must investigate the concerns raised by service users in relation to staff practices and inform the Commission of the outcome of this investigation. Systems must be put in place to 31/10/06 ensure that all areas of the home are kept well maintained, safe and clean. The constant noise of the call 30/11/06 system must be addressed. Service users must be consulted 31/10/06 about appropriate designated smoking areas; any smoking areas must not impact on the health & welfare of others; and any agreed designated areas must be incorporated into the homes policies and Statement of Purpose.(Timescale not met 31/03/06). A fire risk assessment must be completed, to include those people who smoke in their bedrooms. A review of staffing levels must be carried out to ensure that sufficient staff, who are suitably experienced and trained, are on duty at all times to ensure the safety and welfare of the service users. The manager must carry out a full audit of all staff training to ensure that 50 of the care staff have completed the NVQ level 2 qualification in care. Staff recruitment procedures must be improved as discussed within the body of the report. All staff working with people with dementia must be provided with in-depth training in this area. The Commission must be informed of the outcome of DS0000063778.V298052.R01.S.doc 14 OP19 OP38 23(4)(e) 15/08/06 15 OP27 18(1)(a) 15/08/06 16 OP28 18(1)( c )(i) 31/10/06 17 18 19 OP29 OP27 OP30 OP31 19 18(1)( c ) (i) 9 31/10/06 31/12/06 30/09/06 Page 31 Thornbury Care Centre Version 5.2 20 OP33 24 investigations into the conduct of the registered manager. Systems must be put in place to obtain the views of service users and their relatives and to measure the home’s success in meeting its aims and objectives. (Timescale not met 31/03/06). All staff must be appropriately supervised. The manager must ensure that all staff have completed up-todate training in relation to health and safety matters. Action must be taken by the manager to identify risks to the health and safety of service users and as far as possible eliminate these. 31/12/06 21 22 OP36 OP38 OP27 18(2) 18(1)(a) 31/10/06 31/10/06 23 OP38 13(4)( c ) 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP15 OP21 Good Practice Recommendations A review of the mealtime arrangements should be carried out to ensure that this is a relaxed enjoyable experience for all service users. Consideration should be given to the layout of the bathrooms to ensure that staff and service users can safely use the lifting equipment. Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 Thornbury Care Centre DS0000063778.V298052.R01.S.doc Version 5.2 Page 33 - 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!