CARE HOMES FOR OLDER PEOPLE
Thorncliffe House 15 Thornhill Park Sunderland SR2 7LA Lead Inspector
Mrs Elsie Allnutt Announced Inspection 17th January 2006 10:00 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 Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 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. Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Thorncliffe House Address 15 Thornhill Park Sunderland SR2 7LA 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 5109736 0191 5109736 Mr Philip Longmore Care Home 19 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (19), of places Physical disability over 65 years of age (2) Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th September 2005 Brief Description of the Service: Thorncliffe House is a registered care home, which provides permanent accommodation with personal care and support for up to a total of nineteen older people, some of whom may have dementia needs. Within this total, the home may also provide a service to a limited number of adults with a physical disability. Nursing care cannot be provided. The property is a three storey Victorian detached house, with bedroom accommodation and WCs on each floor; bathing areas are located on floors one and two. A passenger lift serves all three. Located on the ground floor, are a large lounge and a further openplan lounge/dining room for communal use. Situated in a quiet cul-de-sac close to the centre of Sunderland, the home is near shops, parks and transport networks. There is a large, well-kept garden to the front, which Service Users may enjoy in fine weather and at the side, a wide secure area with a ramp, which enables access for people with impaired mobility. The rear ‘yard’ is soon to be converted into a pleasant patio. Plans are in place to extend the property to provide another five residential places, while at the same time improving the access and standards of the existing building and its grounds for service users. Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over one day in January 2006 and took 6.5 hours. Time was spent talking to service users, visitors and staff during which time their views of the service were sought, all indicated that they were satisfied with the service provided. A tour of the building was made as well as an examination of a number of records and a midday meal was taken with service users. Although it is acknowledged that further work is needed, this home has again demonstrated improvements since the last inspection and is progressing well. What the service does well: What has improved since the last inspection? Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 6 The manager and staff have worked hard to establish a new and effective care planning system. Each service user has an individual care plan and those plans that have been transferred to the new system are clearly set out and include appropriate information covering different aspects of care. So that staff are aware of the procedures to take when an abusive situation is observed, or reported to them, some have attended training in relation to the local authority’s adult protection procedures. A copy of the procedures has now been made available in the home, so that staff can refer to it for guidance. Two further bedrooms have been decorated and refurbished, offering an attractive environment for service users and advice has been sought from an Occupational Therapist in relation to changing a bathroom that is not currently used into a shower room. When this work is complete this facility will give more bathing choice to service users. In line with the requirements of the Disability Discrimination Act, the home’s physical environment has been reviewed in consultation with service users and relevant professionals to consider whether access and facilities can be improved for existing service users who experience mobility difficulties. There are now plans in place to build a ramp into the building at the front of the house. This will be addressed during the planned building work to extend the house. So that service users are kept up to date with the plans for the service the Proprietor discusses the plans individually to the service users. This was confirmed by service users who directed attention to the architect’s plans for the work to be carried out on display on one of the walls in the home. All service users and their families have easy access to them. One service user confirmed that they had been assessed for a new electric wheelchair that will be delivered in the near future, this he felt will add to his comfort and independence. A Quality Monitoring System for the service has been put into place that ensures that the service is developed in the best interests of the service users. What they could do better:
So that service users live in a comfortable environment that promotes their dignity any unpleasant odour that might arise within the home should be identified and eliminated as soon as possible. This may include seeking professional advice in relation to promoting continence. To further promote the new care plan system as being effective working documents, the risk assessments and guidelines relating to a particular care plan should be included with that care plan. Staff will then have the entire care plan in one place to refer to and work from and service users will receive a safer more effective service.
Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 7 So that the rights of service users are addressed, in the event of a decision being made that restricts a service user from having a key to their bedroom, the reason should be recorded in the individual care plan and should be the outcome of a risk assessment. All staff should receive training in relation to the local authority’s procedures on the protection of vulnerable adults so that service users are protected from abuse. This will equip staff with the knowledge of who to inform and how to address the procedures to be taken. Although staff take part in regular fire drills that are recorded, the names of the members of staff receiving the instruction should be recorded in the fire file, identifying who, on what date, was present. This will be a record that the manager can refer to in order to monitor who, and who has not, received fire instruction. This is important in relation to the safety of the service users if a fire should break out. So that the environment further improves, the planned renovations should go ahead and all of the service users bedrooms should be refurbished and the furnishings showing wear and tear replaced. This will provide further comfort and pleasure to the service users. So that the manager becomes registered with the Commission for Social Care Inspection (CSCI) and in the process is accepted as a fit person to run the home, she must submit the necessary application forms to the CSCI and register for the Registered Managers Award. This will ensure that the home is run by a person qualified to do so and in so doing protect the service users and provide for them an appropriate service. 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. Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 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 Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The home provides the necessary information to prospective service users so that they can make an informed choice about where to live. This is included in the Statement of Purpose and Service User Guide which is a document accessible to service users. EVIDENCE: The home has developed a comprehensive Statement of Purpose and Service User Guide, they are both well set out and the latter is made accessible to service users with the use of photographs. The Statement of Purpose however must also include a list of the measurements of the bedrooms. The manager stated that a list is available but still needs to be inserted into the document. Service users confirmed that they are given information about the home prior to moving in and are also kept informed of any changes to be made to the home and service and were able to discuss the plans for the new extension. Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 The needs of the service users are appropriately addressed in individual care plans and staff effectively support service users with their social, health and personal care needs in a respectful way and a way that promotes their rights and privacy. EVIDENCE: Of the care files examined all included care plans that had been newly developed since the previous inspection and that cover all aspects of the service users assessed needs. The files are neatly presented identifying the goal and how the need is to be addressed. So that staff support the service users in a consistent way, there are clear guidelines in relation to what support is needed and how it is to be given for staff to follow. Risk assessments are in place with clear guidelines for staff to follow so that the risk is minimised. However a discussion took place with the manager in relation to how effectively risk assessments can be used as an integral part of the care plan. The manager was receptive to the ideas discussed. One risk assessment discussed involved a service user going out of the home independently, records confirmed that the risks had been identified and Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 11 strategies to reduce the risk were in place. The service user confirmed these strategies. Staff confirmed that they have received training in relation to the needs of the service users, the most recent being in dementia care and which they feel has equipped them to address issues surrounding dementia with more confidence. Observation of care practice proved that service users are treat with respect and their rights and dignity are promoted. Staff were observed knocking on the bedroom doors and domestics checked with service users, who had chosen to lock their door, before entering the room. It was suggested to the manager that where a service user does not use a key to their door the reason should be recorded in the care plan. Staff were observed to be discreet when encouraging and supporting service users with personal needs. So that service users’ dignity and comfort are promoted continence charts are used where needed. The charts, which were available, identify the time of the day individual service users need to be supported with their needs. However there was one situation identified where possibly more expert advice is needed. This was discussed with the manager who agreed to address this. Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Service users are offered and receive a varied, wholesome, nutritious and wellpresented menu. This can contribute to their general health and wellbeing. EVIDENCE: A midday meal was taken with the service users that was both wholesome and attractively served. The main meal was hot and consisted of fresh meat and three different fresh vegetables that were nicely cooked. This was followed by a milk pudding again hot and nicely cooked. There was a choice of menu that was displayed on a board in the dining room where service users could see. Several service users confirmed that the meal was a good example of the standard of meals that were served daily. One service user was observed being supported to eat their meal by a member of staff both sensitively and discreetly. A sample of menus from the kitchen demonstrated a variety of three wellbalanced meals that are served daily and several service users confirmed that the food they are served is both plentiful and enjoyable. The cook provided a list of fresh and dried foods provided by reputable dealers delivered weekly. Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home has comprehensive and accessible Complaints and Protection of Vulnerable Adult procedures that protect service users from abuse. EVIDENCE: Adequate procedures are in place in relation to making a complaint and a copy is issued to all service users and their families. Service users and relatives spoken to confirmed that they knew what to do if they were unhappy about the delivery of care or other issues about the service provided. The home has not received any complaints since the last inspection, however there were several compliments from visitors recorded in the compliments book. A complaint was received by the CSCI prior to this inspection that initially had been forwarded to Sunderland Social Services Complaints Department by someone wishing to remain anonymous. There are three aspects to the complaint all of which have been fully investigated and addressed in the main body of this report. Requirements and recommendations have been made appropriately. Effort has been made for staff to access training in relation to the local authority’s procedures relating to the Protection of Vulnerable Adults, however due to the lack of availability of courses not all staff have yet attended. The manager confirmed that there are dates planned for the remaining staff to attend in the near future. During discussion with staff they were able to appropriately explain how they would respond if they witnessed abuse.
Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24 Although many improvements have been made to this home to provide a safe comfortable and clean environment for service users, the work is ongoing and will not be complete for some time yet. Currently the bathing facilities are inadequate and fail to give service users bathing choices. EVIDENCE: The home is currently addressing the many issues raised at previous inspections in relation to the improvements needed to make the building more accessible and of an improved standard. The proprietor discussed his plans to build an extension on to the home to provide accommodation for a further five service users at the last inspection and is currently addressing issues raised by different agencies as a result of submitting the plans. The need to improve accessibility into the home is also to be addressed, along with further refurbishment plans to improve the overall standard of the existing building. This includes improving the bathing facilities and giving
Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 15 service users more choice in this area, as well as the special appliances they may need. Many areas of the home, including some bedrooms, have been decorated providing a brighter and more attractive environment for service users to live. All of the bedrooms examined were decorated with personal effects and one where the service user had physical disabilities had appropriate appliances that promoted their independence. There are plans to refurbish all of the bedrooms before the extension to the building is started. As an end result plans demonstrate that the furnishings will be replaced where necessary to provide a comfortable place for service users to live. Many of the chairs used in the bedrooms and lounge are currently showing signs of wear and tear and are not made of suitable material that can be easily cleaned and meet the needs of the service users. Currently there is a shaft lift to access the second and third floors, however there are second landings that are accessed by two or three steps where service users with bedrooms in these areas need to have good mobility. The home was clean and tidy and reflected good cleaning routines. However a bad odour was found in one part of the lounge and in one of the bedrooms. This was discussed with the manager who agreed to address the problem. Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 16 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 Staffing levels are sufficient in number to effectively meet the needs of service users living in the home. EVIDENCE: Three care assistants, one a senior member of staff, the manager and several ancillary staff were on duty. This is an adequate number of staff to address the needs of the service users currently living at the home. An examination of the staff rotas proved that this number is consistent. The manager confirmed that there is little staff turnover and sickness does not present a problem. Observations of and discussions with staff confirmed that they have the necessary skills to meet the needs of the service users currently living at the home. Staff were observed to interact positively with service users who spoke in a complimentary way about staff attitudes and the level of care they provide. One family member visiting the home on the day of the inspection supported the service users’ views and said, “the staff are good and always there to assist when needed.” A discussion took place with the manager in relation to the home’s proposed increase in number of service users and the need to review the staffing ratio in relation to meeting their needs. The manager agreed that this would be addressed prior to new service users moving in. Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 The manager offers clear leadership and direction to the staff and this has resulted in a trained workforce that offers consistency of care and a home that is run in the best interests of the service users. EVIDENCE: The manager has yet to submit an application to be considered for Registered Manager for this home. She must also register to start the Registered Managers Award and NVQ 4 in Care. In discussion she agreed that both would be addressed. The manager was observed to work and interact with service users and staff both sensitively and professionally and staff confirmed that they liked her approach and felt they were being positively included in the running of the home. Service users also felt that they were kept informed of improvements and changes to be made.
Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 18 There is a Quality Monitoring System in place, and the Quality Monitoring File demonstrates how and when the weekly and monthly monitoring of different aspects of the service takes place. The manager confirmed that she is responsible for carrying this out. Although there were monitoring checklists completed by service users’ relatives in place, it was suggested that although some families had included service users in the completing of the form, the document should also go out addressed to the service user so that their views are always considered. The home has a Smoking Policy that identifies a designated smoking area. Service users were able to identify the area and were observed smoking there. Service users confirmed that the Smoking Policy did not include smoking in bedrooms. A recent inspection by the Fire Service identified three issues that needed to be addressed by the home. The manager confirmed that all had been addressed however it was suggested to keep a record when the home’s Fire Risk Assessment is reviewed and to record any adjustments made. The home is currently recording weekly fire drills. It was suggested that the frequency of fire drills are carried out as directed in the Fire Brigades Fire Precautions Log Book for example, for staff working night shift every three months and for staff working day shift every six months. The manager was advised to record the names of staff involved in the fire drills /instruction and keep the record in the fire file so that the CSCI and Fire Service, if requested, can inspect them. Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X 2 X X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X 3 X X X 2 Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2. Standard OP1 OP8OP19 Regulation 4 13 (1)(b) 12(4)(a) Requirement The Statement of Purpose must include a list of the measurements of the bedrooms. The manager must ensure that professional advice about the promotion of continence is sought and acted upon where necessary and any bad odour found in the home, due to continence problems, must be eliminated. The manager must ensure that the remaining staff that have not received training in relation to the local authority’s Protection of Vulnerable Adults do so. The Registered Person must ensure that at appropriate places throughout the premises there are sufficient assisted bathing facilities. (08.06.05 Timescale not met.) The bedrooms not yet refurbished must be addressed and any furniture throughout the building that needs to be renewed or does not meet the needs of the service users must
DS0000059954.V273234.R01.S.doc Timescale for action 28/02/06 28/02/06 3 OP18 13(6) 30/04/06 4. OP21 23 (2)(j) 30/04/06 5. OP24 16(1)(2) 30/04/06 Thorncliffe House Version 5.1 Page 21 be replaced. 6. OP31 9 The manager must submit an application form to the Commission for Social Care Inspection so that she is considered for Registration. (Timescale of 30/10/05 not met) The manager must successfully complete the Registered Managers Award and NVQ4 in Care. A copy of the home’s current business and financial plan must be made available for inspection. (08.03.05 Timescale not met.) 28/02/06 9. OP31 9(2)(i) 30/06/06 10. OP34 25 (1) 28/02/06 11 OP38 23(4) The home should carry out fire 28/02/06 drills as suggested in the Fire Brigades Fire Precautions Log Book for example, for staff working night shift every three months and for staff working day shift every six months. The names of staff involved in the fire drills and instruction must be recorded and kept in the fire file so that the CSCI and Fire Service if requested can inspect them. 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 OP10 OP27 Good Practice Recommendations The risk assessments should be developed as an integral part of the care plan. When a service user does not use a key to their door the reason should be recorded in the care plan. The staffing ratio should be reviewed in relation to the needs of the proposed additional service users prior to the
DS0000059954.V273234.R01.S.doc Version 5.1 Page 22 Thorncliffe House 4 OP38 proposed extension of the home being completed. The names of staff and the dates they attended when fire training and instruction took place should be included on a separate sheet in the fire file. Thorncliffe House DS0000059954.V273234.R01.S.doc Version 5.1 Page 23 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
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