Inspection on 27/05/08 for Thornbury Residential Home

This inspection was carried out on 27th May 2008.

CSCI found this care home to be providing an Adequate service.

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

Thornbury Residential Home 30/05/07

Thornbury Residential Home 20/04/06

Thornbury Residential Home 15/11/05

Thornbury Residential Home 12/01/05

Thornbury Residential Home 08/10/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Thornbury Residential Home Hempstead Road Uckfield East Sussex TN22 1DT Lead Inspector Michele Etherton Unannounced Inspection 27th May 2008 10:00a 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 Residential Home DS0000021270.V363471.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 Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thornbury Residential Home Address Hempstead Road Uckfield East Sussex TN22 1DT 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) 01825 765502 admin@thornburyresidential.uwtadsi.co.uk thornburycare.co.uk Mr John Johnson Mrs Alyson Johnson Mrs Alyson Johnson Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of nineteen elderly people to be accommodated (19) Service users must be aged 65 years and over on admission Date of last inspection 30th May 2007 Brief Description of the Service: Thornbury is a residential care home providing personal care and accommodation for nineteen older people, being situated in walking distance from the town centre of Uckfield. The registered proprietor has owned and managed the home for over twenty-one years. The property is a two storey detached house with a stair lift for access between the floors. All service users benefit from single bedrooms, five of which have en-suite toilet facilities. There is a pleasant garden at the front of the building that is well maintained with garden furniture available during fine weather. The home also has a patio at the rear of the building; both the garden and patio areas allow easy access for service users. The home is attractively decorated and communal areas comprise of a conservatory leading off from the large main lounge with a separate dining room. The home has three communal bathrooms with assisted bathing facilities and three toilets. At the time of Inspection the accommodation fees at the home range from £400 to £450, with additional costs required for personal toiletries, newspapers and hairdressing. Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection of this service has been undertaken that has taken account of information received from the service and about the serviced since the last inspection. A new Annual Quality Assurance Assessment was not available to inform this inspection, although surveys have been returned from some relatives and staff and their responses have been helpful in informing the inspection planning and in compiling this report. The inspection has also included an unannounced site visit to the care home on 27/5/08 between the hours of 10:00 am and 4:45 pm. During this visit a tour of the premises was undertaken, time was spent with service users, and discussions held with two relatives and three staff at the home in addition to the provider and deputy manager. A range of records’ has also been examined at the home that include examples of care plans, risk assessments, Medication administration records, staff recruitment, training and supervision records. All key inspection standards have been assessed, in addition to those where previous outstanding requirements had been issued or where outcomes became apparent during the site visit. Staff and service users were co operative and helpful during the site visit speaking positively of their experiences of the home and their input has been influential in the compilation of this report. There is currently an adult safeguarding alert raised on the home, this has been investigated and the outcome of this awaited. What the service does well: Service users benefit from living in a clean, safe, and well-maintained environment, it is small and has a comfortable and homely ambience. They are supported to bring personal items from home and personalise their own space. The home provides single occupancy accommodation to all service users. The home demonstrates a commitment to the qualification training of its staff. Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 6 Service users and relatives speak positively of the staff that they generally find helpful and friendly. Service users enjoy a varied and wholesome diet. The management team is co operative with the inspection process, compliant with addressing any shortfalls highlighted and demonstrates a willingness to learn and make improvements within the service where these are highlighted. What has improved since the last inspection? What they could do better: The provider is required to take action to address the following: Further identified improvements in the administration and recording of medication. The management of complaints The management of soiled laundry and non-compliance with infection control procedures. CCTV cameras’ to be removed from internal corridors within the home. To ensure staff employment references are accepted only from persons in authority to provide them. That service users are not left unattended by staff breaks/meetings at any time during daytime shifts Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 7 That staff practice and performance is appropriately monitored and that they have opportunities for regular support on a 1-1 basis from the management team That all service user accidents are recorded, are reported in the accident book and that relevant agencies are notified where there are issues of possible safeguarding, or there is a duty under legislation to report. A number of recommendations for improved practice have also been issued 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. Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 8 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 Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 9 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): 3,4,6 People who receive this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective service users benefit from an assessment of their needs prior to admission to the home to ensure these can be met. The home may not always recognise its limitations in continuing to support some people safely or meet some changing needs. EVIDENCE: Four service user files examined during the course of the site visit provided evidence of initial assessment of prospective service users by the home prior to admission. Discussion with three people about their experiences of moving into the home revealed that in all cases their relatives had received information about the home and had visited on their behalf before the service users were admitted. All the users spoken with were happy with this arrangement and felt they had been involved in the decision. The home Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 10 collects a good range of information from relatives and service users to support their knowledge and understanding of the service user, their needs and their support networks. Examination of some case tracked files and discussion with the provider indicated that appropriate interventions from health practitioners are sought in the event of changing needs, however, discussion with the provider and staff, observation of two case tracked service users including discussion with one, highlighted in one case in particular behaviours that are beginning to challenge the service, it is important that the home recognises and maintains an awareness of its limitations to continue to support some people safely and effectively without undue impact either on their own privacy and dignity or that of other service users through measures implemented to deliver support safely. In this instance CCTV cameras have been installed which the provider has been required to remove from internal areas of the home and this is addressed elsewhere in the report. The home does not have the facilities to provide intermediate care at this time. Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 11 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 People who receive this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plan information provides staff with most of the information they need to know to support service users but not how users would prefer care delivery, there is a lack of attention to mental health needs where these arise. Improvements to the management of medication are progressing. There is a lack of awareness regarding some practices that infringe the privacy and dignity of individuals. EVIDENCE: A sample of four care plans were viewed at the site visit, the home has made progress in the development of care plans and these now contain a good range of information, plans viewed mostly reflect the needs and support of the service users case tracked. Whilst staff demonstrated a good understanding of these’ users day to day needs in most cases, their knowledge around user Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 12 preferences in respect of care delivery is not sufficiently reflected in the care plans to ensure all staff provide the same level of support, care plans would benefit from the inclusion of more detail around user preferences in care delivery. Service users were relaxed and one indicated that routines can be flexible e.g. “If you want more than one bath a week and there is time you can have one, you just have to ask” Care plans viewed evidenced that service users are seeing and signing their care plans, although the frequency of this is unclear. Re-evaluation sheets are completed monthly to record any changes to the plan of care and amendments to the plans noted, there are some notable omissions in respect of mental health and behaviour for two service users case tracked, discussion with staff, observation of two service users and discussion with one, indicated that both have behaviours that are not actively being responded to by the home in the way that staff work with each person, this is evident in the lack of reference made to their present behaviours within the care plans of both. Staff’ are clearly concerned at tackling one service user who they thought had a “look” at times that made them uneasy. Another service user’s behaviour is ignored completely by staff and yet it is clear from a brief discussion with the user that staff responses are a source of anger to them and they expressed aggressive thoughts towards staff who they felt were not supporting them in the way they should be. Behaviour plans have not been developed to help staff to work and respond consistently for the benefit of the service user and to instil confidence in staff. Service users spoken with indicated they have health appointments outside the home and one indicated that they have retained their own dentist and optician although they were unsure how often these are seen, records of contacts with GP’s are maintained and these would benefit from expansion to include records of all health contacts including dentist, chiropodist, optician and any specialist hospital appointments to ensure routine health check frequencies are maintained and monitored and this is a recommendation. Falls monitoring is occurring but is not evidenced within documentation the provider indicated that she is taking action to address falls by consulting with relevant GP’s in respect of service users medications and has also instituted a programme of ensuring service users wear shoes during the day and not slippers, which she believes has been instrumental in reducing the number of falls experienced by individual service users. The home has made improvements to the range of risk assessments it undertakes of service users to ensure that risks to health are appropriately assessed, these would benefit from the inclusion of nutritional assessments also, Risk assessments in respect to environment, moving and handling are also in place. For those service users who travel independently outside of the home risk assessments have been developed, however, the quality and depth of these needs reviewing as discussion with staff indicated that no Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 13 observations or monitoring of service users outside of the home have been undertaken to inform judgements around risk and the users capacity to undertake this safely, with this in mind it is recommended that these risk assessments in particular are reviewed. Previous inspections have resulted in a number of requirements being issued in respect of medication management within the home, this site visit highlighted that in the main these have been addressed, however, a further requirement in respect of specific shortfalls identified during the site visit has been issued. Currently some service users partly self medicate sprays and creams but risk assessments are not in place to support this. The majority of service users have their medications administered by staff their consents to this are not recorded and one service user asked about medication indicated that prior to admission she had managed her own medications and was unclear why she no longer did so, for those service users who the home judges incapable of safely administering their medication capacity assessments should be developed to support this judgement. Care plans lack clarity about medication arrangements where there is a shared responsibility by the user and the home staff. The home is required to address these shortfalls Medication storage is generally good and controlled medications handled appropriately when in use. PRN guidelines have been developed for individual users but these would not benefit from expansion and has been discussed with the provider and is a recommendation. Examination of records indicates that changes to medication by GP’s are being appropriately recorded in care plan information. A discussion with the provider highlighted planned implementation of placebo medication for one service user the provider has been reminded that the implementation of changes to medication regimes must be as the result of consultation with health professionals, user representatives and where possible the service user themselves, where such considerations are made and decided upon there should be a clear audit trail of how judgements have been arrived at and actions implemented. The Medication records indicate that medication is being booked into the home and returned, the provider indicated that stock control has improved although a review of MAR sheets indicated recording content is not consistent and needs standardising and this is a recommendation. An examination of MAR sheets indicated improvements in overall recording of medication apart from some exceptions discussed at the site visit, there continues to be a lack of clarity in respect of the codes used by home staff for non administration of medications and those printed on the MAR sheet, improved clarity is also needed in recording of outcomes of medication errors Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 14 and the actions taken, this was discussed during the site visit and it was agreed that the provider should undertake an audit of medication sheets and consider the introduction of competency assessments for staff. The possibility of MAR sheets being checked for accuracy at staff handover is also an option being considered by the provider to address this problem. It is recommended that the provider progresses suggested improvements in these areas The home is maintaining records of medications for each service user and it has been suggested that these would better inform staff if they could be expanded into medication profiles detailing what each medications is for, whether there are side effects, and users personal preferences around medication administration, and whether there is the possibility of introducing diversity into their administration regime. Whilst in general users spoken with thought that staff were kind and friendly, and provided them with the support they needed when they needed it, several issues that impact on the privacy and dignity of service users were noted, these are: The installation of CCTV in corridors (this has been dealt with elsewhere in this report). Concerns expressed by relatives that as a result of inadequacies within the laundry arrangements shortfalls that occur in service users clothing from lost items are being supplemented from deceased users without consultation or agreement that service users would welcome this. For those service users who arrive at the home with limited clothing this practice may be acceptable on an interim basis, but should not be generally used as a means to filling in for losses as a result of the current laundry arrangements. (See standard 26). The home must also reconsider the practice of noting individuals bathing days on their bedroom doors this is personal to the individual and an alternative location for such information should be found for this information for staff to access. It is recommended that the home review current practice to ensure the privacy and dignity of service users be fully supported. Thornbury Residential Home DS0000021270.V363471.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People who receive this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users living in the home have access to activities although more consideration should be given to individual needs and preferences in activity planning. Flexible visiting arrangements are in place to ensure service users maintain contain with relatives and friends. Some thought should be given to routines within the home that impact on independence and choice. Service users enjoy a varied and wholesome diet and are consulted about menu development. EVIDENCE: No activity was planned on the morning of the site visit although a quiz was undertaken during the afternoon with some user. Discussions with service users indicated that there are some activities and this includes an exercise session. A piece of artwork jointly completed by service users was noted on display in the conservatory. Although service users did not highlight lack of activities as an issue, service users spoken with could not name many activities that they can enjoy in the home, and it is apparent that some activities such as quizzes and games may exclude those with impairments. Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 16 Further thought needs to be given to the range of activities provided and their suitability for the service user group and this is a recommendation. Relatives expressed mixed views about the availability and frequency of activities with three indicating through survey and discussion that there are usually activities and these are suitable for their relative and in the case of another relative who felt there isn’t enough to stimulate the residents, this was disputed by the relatives family member who lives in the home. Relatives spoken with during the visit and feedback from survey responses suggest visiting is flexible and relatives come and go as they please, although one relative commented that meeting in private can be a problem as the home is limited for space. Most residents do not have keys to their bedrooms there is no clear reason for this and user records do not evidence capacity assessments or record decisions by users not to have keys. Those who are located on the first floor and need staff support to use the stair lift do not have freedom of movement to come and go from their rooms as they wish and tend to remain downstairs all day, there is no indication that service users are discouraged from accessing their bedrooms during the day but a relative commented that in their opinion this impacted on the independence choice and freedom of service users. Service users spoken with said they enjoyed their meals and found the food to be “good” A relative commented that the home provided “good home cooked food” and that her relative “eats well” never complains and would do if she wasn’t happy, Another service user stated that “you can tell the cook and she will give you an alternative but you must tell her beforehand, its no good complaining after the meal is served” Menus are up you just have to look. Resident meeting minutes indicate that residents can have input into menu development and that the home actively uses fresh vegetables and home cooked food. A staff member was observed handing biscuits to residents this is clearly unacceptable and the home must promote staff awareness of safe food handling measures at all times, this has been discussed with the provider at the site visit and has also been referred to in relation to infection control practices within the home (see st. 26). Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 17 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 People who receive this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users feel able to express their concerns to staff but the home cannot demonstrate that it is welcoming of complaints or that it manages these appropriately. The home must develop clear rationale for restrictions imposed and decisions regarding these and behaviour management must not be taken in isolation. EVIDENCE: Discussion with service users at the site visit indicates that most find staff and the provider approachable and have no concerns at raising issues. Complaint information is displayed on the notice board in the entrance to the home. A review of the complaints record highlighted only two complaints recorded in 2007, but details of the investigations and outcomes were unclear, there is evidence within the file of other older complaints but these also are not recorded or their outcome. Staff’ are aware of the complaints procedure but may not realise the importance of listening to, and then acting on residents’ concerns. A relative indicated that she found the provider unapproachable and that she had made a complaint previously but this had not been dealt with, she reported that she had recently complained to the provider again, no record of Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 18 this complaint has been made or the outcome. The provider is required to ensure that all expressions and complaint are suitably recorded with details of investigations and outcomes clearly noted. An adult protection alert is currently outstanding on the home and the outcome of this is still awaited, although the provider believes this to now have been closed. Staff spoken with had an awareness of what to do in the event of witnessing abuse but the provider must ensure that adult protection training is provided to all staff at least once every two years and staff are made familiar with local protocols and this is a recommendation. Recent staff complaints have highlighted that the whistle blowing process within the home may not instil confidence in staff and needs reviewing, discussion with staff also highlighted concerns that confidential staff information is not always handled in a manner that maintains its confidentiality and breaches have occurred, this has been discussed with the provider who has been asked to consider the present office arrangements and how security can be improved e.g. keeping the office door shut when sensitive issues are under discussion. Restrictions in place are not supported by clear rationale and have not been approved within a multi disciplinary setting, there are restrictions in the administration of medication by service users which are not supported by capacity assessments, only about three users have their own room keys, it is unclear why others do not and where this is a free choice this is not recorded in care plan documentation, it is recommended that the provider ensures that where covert or restrictive practices are in place these are clearly supported by all stakeholders and are subject to review and monitoring. The Risk assessment process particularly for those service users travelling independently outside the home is not sufficiently robust to ensure their safety. Behaviour guidelines have not been developed for individuals displaying difficult or challenging behaviours to ensure staff respond consistently, there is a lack of awareness shown by provider and staff that these behaviour issues exist and they are not noted within care plan information, the home is recommended to develop guidelines for staff to work to. Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 19 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): 19,22,24,26 People who receive this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users’ benefit from living in a clean, safe, comfortable, environment, in which they can personalise their own space with their possessions. Service users have access to necessary aids to support their care needs but some limitations in the environment impact on their privacy, dignity and independence. Laundry arrangements are in need of review EVIDENCE: A tour of the premises has been undertaken during the site visit, areas of accommodation viewed included all communal areas and a sample of bedrooms, bathrooms and toilet areas. The home is maintained to a good standard of cleanliness. Décor and furnishing’ are in good order and add to the homely and comfortable appearance of the home. No unpleasant odours have Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 20 been noted at the site visit and none of the relatives, or service users commented on this as a problem. Some rooms have en-suites and there are a good range of toilets and bathroom areas, although one relative pointed out space as being a problem with one downstairs toilet in particular, this has inadequate space for staff to support individuals appropriately or for service users with zimmer frames or other walking aids space to turn around. The home has three staircases one of which has a stair lift for those with mobility problems who need to access the first floor. CCTV has been installed in two upstairs corridors and also overlooking the outside gate, the internal cameras have been pointed out to the provider as an infringement of the privacy and dignity of the service users with no clear rationale for their installation and no consensus from other users or their representatives. The provider has been required to remove the CCTV from corridors and has agreed to do so. The provider has been asked to remove a bed from a downstairs room used by waking night staff, and to replace this either with more appropriate seating or to consider the continued use of this room in relation to discussions held regarding improvements to the laundry arrangements. Aids are in place to support the care needs of service users and these are appropriately serviced. Individual bedrooms are nicely decorated and service users have been able to bring personal items to personalise them and a record is made of these. Service users do not routinely have keys to their bedrooms, and should be offered this choice, capacity assessments should be in place for those service users who are not deemed capable of holding a key to support this judgement, and this is a recommendation. Discussion with the manager and staff indicated that water temperatures are regularly checked, some staff reported that water temperature is generally luke warm, with only one room where water is very hot, other service users would like hotter water and consideration needs to be given as to whether the temperature is now too low and needs to be raised. Fire extinguishers were noted as being serviced. A review of the fire log confirmed that testing and servicing of equipment is happening routinely, the fire alarm is now due for servicing and the provider has been reminded of the need to pursue the contractor to undertake this service in a timely manner. Records indicate that Portable appliance and nurse call have been tested within the last twelve months. The home has established frequencies for staff fire drills, however, records indicate that the home is not maintaining these, it is recommended that this is reviewed to ensure staff are appropriately trained to Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 21 respond effectively in the event of a fire, fire training has been provided recently and the home should ensure all staff have attended fire training on a regular basis and are appropriately briefed on evacuation plans and fire arrangements. The home has two laundries one on each floor, discussion with staff indicates that laundry for both floors is mixed and not confined to the floor in which the laundry is located as intended, soiled laundry is also mixed with unsoiled, and although staff understood the appropriate measures needed for good infection control in respect of laundry, they do not carry this out and the soluble “red” bags to separate soiled laundry out are not provided. The home is required to ensure that foul laundry is washed at appropriate temperatures and separated from normal laundry items to ensure good infection control is maintained. Both laundries have inadequate space and are unable to store cleaned items in baskets or on shelves before return to service users this may contribute to problems reported by service users, staff and relatives of items of service users clothing going astray. Various options for improving the laundry were discussed with the provider during the site visit and it is recommended that the existing laundry arrangements be reviewed. Observations of one staff members practice during the site visit highlighted some concern regarding awareness of good food hygiene standards and infection control, this has been raised with the provider and there is an expectation that all staff will have completed mandatory food hygiene and infection control training and their competency assessed. Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 22 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 People who receive this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home ensures there are enough staff on duty to support service users but the structure is in need of review to ensure lines of accountability and responsibility are in place, there is a commitment to the training of staff but underpinning knowledge and skills in the form of induction and mandatory core skills training need to be maintained. Progress has been made in developing a more robust recruitment procedure but further improvements are needed in the pursuit and verification of employer references. EVIDENCE: Discussion with service users and relatives indicated that they are happy with staff attitudes and numbers. Staffing levels do not appear to feature as an issue either in survey information or in direct interviews. Staff’ attitudes although highlighted as an issue in respect of residents in some staff survey feedback was not apparent either from observation, or discussions and feedback from relatives or users during the site visit. The present staffing structure provides no facility for a senior to be on duty at those times when the provider and deputy are not, no one staff member takes responsibility and at present reference would be made to the provider or Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 23 deputy where possible, this arrangement has been discussed with the provider who reports that a review of the structure is currently underway. A tour of the premises highlighted the practice of staff taking breaks at the same time leaving service users unattended, this has been discussed with the provider who sees some merit in enabling staff to have time together; whilst it is acknowledged that staff may benefit from opportunities to discuss practice issues with other staff on the same shift this should not be at the expense of service users safety or general comfort and they should not be expected to wait overly long when seeking staff support, the provider is required therefore to ensure that there are staff on the floor monitoring the welfare of service users at all times. Recent turnover of staff has reduced the number of NVQ2 trained staff employed although the home demonstrates a commitment to NVQ training of staff and a good proportion have achieved this to date, a number of staff are completing the course currently and others are awaiting final assessment consequently the home should attain more than 50 trained staff again shortly. Staff spoken with during the site visit confirmed provider support for their training in NVQ2 and 3, training profiles are in place for staff although it was unclear if all staff have completed all mandatory training, as not all have attended adult safeguarding training. Staff files of the newer staff on duty during the site visit have been examined. These indicate that improvements have been made to the recruitment procedure and the home is gathering more information about prospective staff to inform their decision making, this includes full employment histories, and information about reasons for leaving previous care roles, this information would benefit from more detail. The home should consider expanding the current health declaration and this was discussed in detail at the site visit. Whilst all necessary checks and references are being undertaken the quality of references accepted is a source of concern as they are not always from the last or recent employer, but in some instances a lower level senior or work colleague. The provider is required to ensure that employer references are sought from current or last employers and that in all cases employment references are accepted only from those people in authority to provide them. Staff reported their experiences of induction and in two out of three cases this entailed shadowing other staff and completion of induction standards workbook. One staff member indicated that although they had been working at the home for some weeks they were still awaiting an induction and had no awareness of where policies and procedures might be located and had not been formally shown the fire arrangements. These omissions have been taken up with the provider who is insistent that this is not routine practice and have occurred as the result of trying to address gaps in staffing hours caused by the short notice departure of a few staff recently. The provider must ensure that induction for all staff is provided to a consistent standard, and that all staff’ Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 24 have achieved mandatory core skills. Not everyone has undertaken adult protection training and along with other core skills the home should be ensuring these are updated or completed Thornbury Residential Home DS0000021270.V363471.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 People who receive this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is generally well managed, the provider has completed an appropriate level of training and demonstrates a willingness to improve and address identified shortfalls within the service. There is a need for the home to develop quality assurance and staff supervision systems to ensure the best interests of service users are maintained. Improvements have been made in recording but the home must ensure that all accidents and incidents are recorded and that other agencies are notified where necessary. Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manager confirmed she completed her training last year as stated and certificate is displayed in office. Feedback from staff indicates that confidentiality of staff information is not well maintained, and this would seem to be supported by complaints made to the provider by former staff regarding similar breaches and a culture of bullying within the staff team that has not been addressed. Discussions with current staff indicate that whilst they find the provider approachable and feel that there has been an improvement in staff relationships, there remain concerns at the confidentiality of the whistle-blowing process and the overall management of confidential information. Measures to address some of the staff concerns in regard to maintaining confidentiality have been discussed during the site visit with the provider. The provider reported that a survey of service users was undertaken in 2007 but analysis of their feedback has not taken place, a published report of findings and outcomes for users has also not been produced. There is currently no system for self assessment and quality assurance although the provider reports that she has identified information to guide them in developing their own quality assurance system, and the home is recommended on this occasion to progress this and to evidence how user consultation and feedback influences service development. The provider has a business plan but this does not reflect year on year service developments nor how user consultation and feedback influences this. User and staff meetings are now happening and the provider is planning for these to occur more regularly, minutes of these were noted. The provider reported that the home does not manage the finances of its service users and retains no cash sums on their behalf. A system for the supervision of staff is in place and staff reported they had met on occasion with the provider although it is clear that the frequency of supervisions has slipped. There are practice issues that need to be addressed and the provider must demonstrate that observation and monitoring of staff practice is in place, there has been a culture of bullying within the home and the absence of supervision records fails to evidence how this has been tackled by the management, or how staff who have been the subject of bullying have been supported, the provider is required to evidence clearly within records that staff practice is monitored and that an observational element forms part of this. Health and safety checks and servicing of equipment are being undertaken routinely within suggested timescales, and samples of servicing certificates have been noted. Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 27 Accident reporting and recording is in most cases appropriate although there are indications within daily records viewed for one service user that not all accidents in which they have been involved although noted in daily records are being recorded also within the accident report book, falls sustained by this individual are also not always being recorded. Incidents involving the service user wandering out from the home, and in one instance a possible car accident have not been notified to CSCI under regulation 37 of the Care Homes regulations 2001 this should also have been referred to the adult safeguarding team, the provider is required to ensure that all accidents and incidents are recorded appropriately and that notifications are made to relevant agencies where there are issues of safeguarding or regulation requires them to do so. Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 3 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 2 2 2 Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 29 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 Timescale for action 31/07/08 2. OP16 22 3. OP19 23(1) 12(4)(a) The provider shall ensure that: 1) Risk assessments are developed for service users who are self or part administering their own medication. 2) Where medication is administered by staff consents to medication are in place 3) capacity assessments are developed to support judgements that service users are incapable of self administration 4) Medication arrangements for individuals are stated clearly within care plan information, including shared responsibility with staff. 5) Can evidence medication errors are investigated and reported appropriately with clear actions and outcomes The provider must ensure that 14/06/08 all concerns and complaints are recorded, and can evidence these are investigated and outcomes made known to the complainant. The provider must remove CCTV 30/06/08 cameras from communal DS0000021270.V363471.R01.S.doc Version 5.2 Thornbury Residential Home Page 30 4. OP26 5. OP27 6. OP29 7. OP36 8 OP38 corridors The provider must make arrangement for the safe management of soiled and foul laundry separate from normal laundry and in keeping with standards of infection control 18(1)(a) The provider must ensure that service users are not left unattended at any time as a result of staff breaks or meetings 19(1)© The provider must ensure the authenticity and verification of all references supplied and that where these are from a current or former employer they are provided by someone in authority to do so 18(2) The provider must ensure that staff practice is routinely monitored and assessed and this includes an observational element. The home must evidence that staff are provided with individual opportunities to seek support. 17, 37 sch The provider must ensure that 4(12) all accidents to service users are recorded, and reported in the accident report book, and to inform the relevant agencies where there is an issue of safeguarding or a requirement to do so under legislation 16(2)(e)(j ) 14/06/08 14/06/08 14/06/08 14/06/08 14/06/08 Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 31 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. 3. Refer to Standard OP7 OP8 OP9 Good Practice Recommendations Home to review risk assessments of those people currently travelling independently outside of the home. That a health contact sheet is developed to record all routine and specialist healthcare interventions That medication recording is improved by: 1) Expansion of individualised PRN guidelines 2) Standardisation of recording of stock control information 3) Implementation of a system to audit MAR sheets 4) To standardise and clarify non administration of medication codes used by the home and those printed on MAR sheets 5) Implement competency assessments for administering staff A review of care practice that may impact on the privacy and dignity of service users A review of activities in consultation with service users and taking account the needs of visually and hearing impaired service users That service users are safeguarded by: Adult safeguarding training to be provided to staff a minimum of two yearly and that staff are made aware of local protocols Staff’ are provided with individualised behaviour guidelines to provide support consistently to those service users with identified and challenging behaviours. Restrictive or covert practices being supported by clear rationale and subject to scrutiny and discussion within a multi disciplinary setting and given clear review dates To ensure frequency of fire drills is maintained for all care staff. Service users to be provided with keys to their rooms unless they lack capacity and a capacity assessment or risk assessment suggests otherwise Laundry provision, localities and arrangements to be reviewed DS0000021270.V363471.R01.S.doc Version 5.2 Page 32 4. 5. 6 OP10 OP12 OP18 7 8 9 OP19 OP24 OP26 Thornbury Residential Home 10 OP33 Home to progress plans to develop quality assurance system and evidence how consultation and feedback from users influences service development Thornbury Residential Home DS0000021270.V363471.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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