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Inspection on 23/09/08 for Thorncliffe Grange Nursing Home

Also see our care home review for Thorncliffe Grange Nursing Home for more information

This inspection was carried out on 23rd September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

On entering the home the atmosphere was relaxed and very welcoming and staff ensured any visitor was greeted warmly. We spoke to a number of residents who told us "Staff look after me well enough", "Staff are very kind", "(I am) very glad I am in here", "they are really good" and "Staff come if I press my buzzer".

What has improved since the last inspection?

The Service User Guide has been reviewed and information has been updated where necessary. The way medication is dealt with had improved since the last visit with the manager carrying out regular audits to check that staff are administering medication in accordance with agreed policies and procedures and that medication is being appropriately recorded when received into the home and when being disposed of. We saw that the premises have been maintained to a good standard and that redecoration has taken place in a number of areas throughout the home. Some bedroom furniture has been replaced and a number of specialised beds have been purchased for people who require nursing in bed. A new patio had recently been laid to the rear of the property and new dining furniture had been purchased for both dining rooms.

What the care home could do better:

We saw that the carpet on the landing and stairs near room 36 had holes and was threadbare in places. Priority should be given to replacing damaged or unsuitable fixtures, fittings and equipment that could place the health and safety of residents and staff at risk.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Thorncliffe Grange Nursing Home 2-4 Windmill Lane Denton Tameside M34 3RN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: John Oliver     Date: 2 3 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Thorncliffe Grange Nursing Home 2-4 Windmill Lane Denton Tameside M34 3RN 01613200740 01613207374 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sarah Hitchcock Type of registration: Number of places registered: Partnership Caring Limited care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: For 26 - 50 service users requiring nursing care 2 Registered Nurses to be on duty over each 24 hour period. For up to 25 service users requiring nursing care 1 Registered Nurse to be on duty over each 24 hour period. No service user to be admitted into the home who is under 55 years of age. The Manager must be supernumerary at all times. The home is registered for a maximum of 50 service users to include up to 15 DE(E), up to 50 OP, up to 50 PD, up to 50 PD(E). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Care Homes for Older People Page 4 of 27 Over 65 15 50 50 0 0 50 Brief description of the care home Thorncliffe Grange provides accommodation for up to 50 service users requiring personal and nursing care. The accommodation is provided within two converted Edwardian houses that are connected by a purpose built extension and link. Most rooms are single, some with en-suite facilities and all are provided with washbasins. The home is located off the main A57 in the town of Denton. It is on the main bus route and is close to Denton town centre. Parking is available near the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was undertaken as part of a key inspection, which includes an analysis of any information received by us (the Commission for Social Care Inspection) in relation to the home prior to the site visit. This visit, which the home did not know was going to happen, took place over the course of 8 hours on Tuesday 23 September 2008. During the course of the site visit we spent time talking to the residents, the registered manager and a number of staff on duty to find out their view of the home. Before the site visit we sent the manager of the home an Annual Quality Assurance Assessment (AQAA) document for them to complete and return to us with information Care Homes for Older People Page 6 of 27 about the service they provide. This was returned before the visit took place and contained a lot of information that helped us to assess the service being offered by the home. At the time of this site visit the fees charged ranged from 370.53 pounds(single en suite) to 495.27 pounds (nursing). What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service are provided with information about the service prior to admission and receive a full assessment of their needs. Evidence: Since our last inspection visit the service user guide and statement of purpose have been reviewed and updated. All potential people using the service receive a pre admission assessment prior to moving in the home and the registered manager is usually the person who would carry out this assessment. If the manager is on holiday or not available a registered manager from another home within the organisation will carry out the assessment. Details of the assessment are completed on a document called Daily Living and Needs Assessment. Care Homes for Older People Page 10 of 27 Evidence: We looked at the files belonging to five of the most recently admitted residents. We checked the admission paperwork for one person and found that a full assessment was carried out on 11/09/08 at the hospital and an admission date for Thorncliffe Grange was then arranged for 15/09/08. We saw evidence to demonstrate that the family had been kept fully informed of the assessment process and that the assessment also included details of the social worker, general practitioner and relevant family members. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were in place that detailed the needs of the individual resident and supporting policies and procedures were in place to ensure the safe handling and administration of medication in the home. Evidence: Each person living in the home has a detailed care plan on file that gives clear directions to staff as to how to provide care to meet their individually assessed needs. Risk assessments were also included in those files examined. Both the care plans and risk assessments had been reviewed on a monthly basis. A separate file was kept with information relating to each resident being supported with wound care. Details in this file included diagrams drawn up to highlight areas of wound care and, in some instances, photographs, with the permission of the resident. Information was available within the written notes and records to demonstrate that other health care professionals including doctors, district nurses and community Care Homes for Older People Page 12 of 27 Evidence: psychiatric nurses made regular visits to residents. Residents spoken to were very complimentary about the service they received in the home and comments included, Staff look after me well enough, they treat me with respect and always help me with my personal care, Staff are very kind and I get a bath when I want one, My carers give me a bath and (I am) very glad I am in here, they are really good and Its a place to be proud of. Medication in the home is administered via a monitored dosage system that is supplied by a local pharmacy. Nursing staff have the responsibility for administering medication to those residents who require nursing care and senior care staff have the responsibility for administering medication to those residents who require personal care only. We examined the medication that is administered by nursing staff and those Medication Administration Records (MAR) checked were found to be correct and signed for accordingly. All medication received into the home had been recorded on the MAR. We checked the balances of some medication to be administered as and when required and found that these balances were not always correct as some medication had been carried forward from the previous months supply but had not been added to the new months balance. It is important that all medication can be accounted for at all times. Some medication details had been handwritten onto the MAR and this is usually when an antibiotic has been prescribed. It would be good practice if two people carry out this task to ensure any potential risk of errors occurring in the recording were minimised. Both staff should then sign the MAR. We saw care plans that described when painkillers might be needed for residents who are unable to communicate verbally. A number of residents were prescribed Controlled Drugs and balances of this medication was checked and found to be correct. A recent change in legislation means that the storage cabinet used to store such medication may no longer be appropriate and the manager confirmed that she would contact the pharmacy to check this out. The manager also confirmed that all unused or discontinued medication is recorded and then returned to the pharmacy on a monthly basis. During the visit we saw that residents generally appeared well presented, clean and tidy and staff were seen to treat residents with respect, dignity and patience. Residents spoken to told us, We get well looked after, Staff are very kind, I get a Care Homes for Older People Page 13 of 27 Evidence: bath when I want one, my carer gives me a bath every Wednesday, I am very satisfied with what they (staff) do for me, Very glad I am in here, They (staff) are really good and Staff come if I press my buzzer. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily routines in the home demonstrated that residents were encouraged to maintain control over their lives, were encouraged to maintain contact with the community and are provided with a wholesome and well balanced diet. Evidence: Since the last key inspection, improvements have been made in the number of activities that are available in the home. Each person now has a care plan addressing daily living and social activities and gives details of the individuals previous lifestyle regarding likes/dislikes, hobbies and activities they enjoyed prior to moving into Thorncliffe Grange. Residents spoken to told us, We will be playing bingo this afternoon, I usually win and Some of the staff find time to sit and talk with you, you dont always want to be involved in activities, its nice just to talk. Visitors to the home were seen to come and go throughout the day and examination of the visitors book demonstrated that lots of people visited the home on a regular basis. Care Homes for Older People Page 15 of 27 Evidence: The kitchen is situated in the basement of the home and at the time of this visit was found to be very clean, tidy and well organised. A discussion with the cook on duty demonstrated that she understood peoples likes and dislikes and understood about individual residents dietary needs. The cook maintained regular checks of fridge and freezer temperatures and maintained records of cleaning schedules carried out. Menus are planned using a three week rotating menu and these were displayed on the back of all bedroom doors to make sure residents had an opportunity to think about what meals they would prefer to order. On the day we visited, the main meal was braised steak, croquette potatoes, broccoli and cauliflower followed by banana and custard. People who did not want this meal were offered alternative choices. We watched staff serving meals to those residents in the dining room on the ground floor. A number of residents needed varying degrees of assistance whilst having their meal ranging from needing food to be cut up to actually being fed their meal. Staff approached this sensitively and assisted people in an unhurried way to make sure the resident had time to enjoy their meal. A lot of residents were unable to confirm if they had enjoyed their meal but observation of those being assisted and the empty plates indicated they did. Residents spoken to about meals in the home said, (I) enjoy my meals, I really enjoyed my dinner, plenty of good food and You are not forced to have anything you dont want, you get good choice. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies, procedures and training measures were in place for staff to support residents to raise any issues of concern and to protect residents from neglect a.nd abuse Evidence: The complaints procedure was displayed throughout the home including the hallway and in individual bedrooms. Residents spoken to during this visit were very clear about how to raise a concern or complaint. Since our last key inspection visit the home has received and recorded 5 complaints, all of which had been dealt with satisfactorily. The home has a policy and procedure in place to respond to any allegations of abuse that may arise. The manager confirmed that all staff had received formal training in the Protection of Vulnerable Adults (POVA) and those staff spoken to were very clear about what action they would take in the event of an allegation of abuse being made. Comments from staff included, I would see the manager or the senior member of staff on duty, We have guidance on the policy file and I would tell the manager or ring social services. Residents spoken to said, I would speak with Sarah (manager), she is very kind and I could tell any of the girls, they would make sure I was alright. Further discussion with the manager confirmed that there had been two referrals to the Protection of Vulnerable Adults contact centre in Tameside since our last inspection Care Homes for Older People Page 17 of 27 Evidence: visit and both referrals had been thoroughly investigated and concluded by the agencies involved. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment was clean, tidy and comfortable however some areas of the home could place residents and staff at risk. Evidence: Since we last visited the home in October 2007 a programme of redecoration and refurbishment has been satisfactorily maintained and on the day we visited the maintenance person was in the home carrying out routine maintenance tasks. We saw that many areas of the home have been redecorated and new dining furniture has been provided in both dining rooms of the home. We looked at a number of bedrooms all of which were found to be clean, bright and personalised according to the wishes of the person whose room it is. The furniture in a number of bedrooms had been replaced and a number of nursing profile beds had also been purchased to aid the comfort of those residents requiring nursing care. Bathrooms and toilets were appropriately maintained and those seen all had privacy locks in place. No unpleasant odours were detected in any parts of the premises viewed. The carpet on the landing and stairs near room 36 had holes and was threadbare in Care Homes for Older People Page 19 of 27 Evidence: places. Discussion with the manager indicated that this had been damaged when bringing up new beds to the upstairs bedrooms. As these stairs are also a fire exit it is important that they are safe to use at all times and the carpet on this landing and stairs must be replaced. The laundry area is sited in the basement of the home and was found to be well organised, clean and tidy and equipped with appropriate washing machines and dryers. Hand washing facilities were also available for staff. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of staff are employed in the home, with staff training and development helping to ensure staff are competent to carry out their jobs. A robust recruitment and selection process helps to protect residents from unsuitable people working in the home. Evidence: On the day we visited the home staffing levels appeared appropriate to meet the needs of those residents living in the home and staff and residents spoken to said that staffing levels had improved although there is sometimes a shortage of staff due to short notice sickness. Nine members of the staff team had successfully obtained a National Vocational Qualification (NVQ) at Level 2 and a further seven were in the process of completing this qualification. Examination of four staff files indicated appropriate pre employment checks had been carried out prior to the person commencing working in the home including Criminal Record Bureau (CRB) enhanced disclosure checks. Nurses PIN numbers are checked on a monthly basis. Care Homes for Older People Page 21 of 27 Evidence: All staff received training and those staff spoken to during the course of this visit confirmed this. We saw evidence on those staff files examined that all new staff receive a full induction in line with Skills for Care followed by regular probationary meetings with their line manager. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents living in Thorncliffe Grange benefit from having the support of a manager with skills to provide a good quality service and procedures in place to promote their interests and well being. Evidence: The manager is a Registered Nurse and has many years experience of managing both nursing and residential homes and has just successfully completed the Registered Managers Award. To further expand her knowledge and skills the manager has also recently completed a train the trainer course, which will enable her to train the rest of the staff team in such areas as moving and handling and the use of various types of hoists. Staff told us that the manager is supportive and approachable and manages the home very well. Comments included, We have a very good manager who has an open door policy and The manager is very good and is very fair. Care Homes for Older People Page 23 of 27 Evidence: In order to maintain an overview of how well the service is meeting the needs of those people living in Thorncliffe Grange the manager and management team carry out regular audits of the service. This is done using questionnaires, meetings and regular spot checks. At the time of our visit the area manager was also visiting the home to carry out her monthly check of the service being provided and to speak with both residents and staff on duty. A business plan has been developed for the service and this was readily available in the hallway of the home along with profiles of each member of the staff team, including photographs. The manager carries out an annual quality audit of the home and sends out questionnaires to residents, relatives and other health care professionals such as doctors and district nurses. We examined a number of returned questionnaires from a survey carried out in June 2008 and all were extremely positive about the service being provided. The home does not manage the financial affairs for any resident and only holds small amounts of money for individual residents for things such as newspapers, sweets and toiletries. Records and receipts are maintained for all such transactions. Staff told us that they regularly receive one to one supervision and records were kept of these sessions. The manager confirmed within the Annual Quality Assurance Assessment (AQAA) returned to us before the inspection took place that the servicing and maintenance of all equipment used in the home had taken place. A random selection of reports relating to maintenance of equipment was checked and included, Landlords Gas Safety, lift maintenance and emergency lighting. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 The worn carpet on the stairs and landing near to room 36 must be replaced. This is dangerous to both residents and staff. 30/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 A suitable system should be developed to monitor and maintain correct balances of medication that is prescribed to be given as and when required. Where prescribed medication needs to be handwritten onto medication administration records, it would be good practice if two members of staff completed this task in order to minimise the risk of any errors in recording occurring. Both members of staff should then sign the record. 2 9 Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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