CARE HOME ADULTS 18-65
Thornebury Nursing Home 5,7 &9 Langthorne Road Leytonstone London E11 4HL Lead Inspector
Sharon Lewis Unannounced Inspection 25th January 2007 12:20 Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 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 Thornebury Nursing Home DS0000065852.V327788.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 Adults 18-65. 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. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Thornebury Nursing Home Address 5,7 &9 Langthorne Road Leytonstone London E11 4HL 020 8539 9443 020 8539 9443 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) Outlook Care Helen Samangah, Acting Manager Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th February 2006 Brief Description of the Service: Thornebury Nursing Home is registered to provide care for up to 16 service users of either sex who have enduring mental health problems. The aim of the home is to provide rehabilitation and to enable service users to move to more independent living facilities. For the majority of residents this is a long-term aim. The building is comprised of three two-storey buildings, which have been adapted and converted to provide single rooms and communal areas for service users and office space for staff. The home is situated in a residential area of Leytonstone with easy access to local facilities and public transport. The home is adapted for wheelchair users and those with limited mobility, including four of the bedrooms. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Unannounced Inspection was undertaken on a Thursday afternoon to the evening and lasted seven hours. The overall objective of this Inspection is to ensure service users are receiving the best possible care and their welfare is safeguarded and promoted at the care home. In addition to checking the home’s compliance with the legal requirements made at the last Inspection. The Inspector spoke to seven service users currently living at the home. Individual discussions were also held a relative, a Support Worker/Activity Officer and the Acting Manager. Service users files, medication and medication administration records, fire safety records and other relevant documentation were examined. A tour of the premises was also undertaken. The Inspector would like to thank all service users, relatives and staff members for their assistance with this Inspection. What the service does well:
Discussions with service users and observations evidenced they were happy with their care. One service user stated “We are all friends, staff and service users work together.” All service users were comfortable in their surroundings. Service users respected each other’s space and demonstrated a caring attitude to each other. The Service User Guide uses lots of photographs to illustrate topics. Service users were shown taking part in various activities. This document was seen as more meaningful as service users, staff and local amenities were reflected throughout. Service users enjoy a range of social activities, which are well documented through photographs. The activity programme includes keep-fit, relaxation, newspaper group, reading group, art and crafts. Service users participated in a range of themed parties that have celebrated Bollywood, Mexico, Halloween, Africa and Valentines Day. Religious festivals including Christmas and Eid are also celebrated. The home has also had a Fun Day and barbecues during the warmer weather. Service users have enjoyed a holiday to Butlins. Day trips have included going to Southend, Lakeside, Regent St Christmas Lights,
Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 6 Margate and Epping Forest. The home has a range of board games, a dvd player and a computer is scheduled to be purchased. Service users attended various support and day facilities linked to their individual needs. These included a local day centre for people with mental health support needs, a support group for African-Caribbean people and a specialist physiotherapy group. Menus were examined and found to be nutritious, balanced and reflected a range of cultures. Service users enjoy traditional White British, Chinese, Italian and halal meals. Service users are offered three meals a day, snacks and drinks. A cooked breakfast is available once a week and fresh fruit is readily available in the kitchen. The home has a cook and homemade snacks and cakes are promoted. It was good to see that the home keeps a record of compliments. Two compliments have been received since the last Inspection. The home has been thanked for their charity donation from their Fun Day. Service users benefit from a choice of lounge areas. There is a main dining room with adjoined lounge area, a smoking lounge and a smaller lounge with activity area. All lounges were found to be warm, clean and cosy. An air ventilator is available in the smoking lounge. Service users moved freely throughout the home and were very comfortable in their surroundings. All lounges had televisions and an individualised atmosphere. The organisation has a staff training programme and a commitment to National Vocational Qualification (NVQ) training. Mandatory staff training includes first aid, food hygiene, health and safety, manual handling and fire safety. Staff receive additional training specific to the service user group. This includes the following: medication, mental health awareness, infection control, information technology (IT), challenging public stigma and breakaway techniques. Staff receive additional self-development training and performance appraisals and performance management. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection?
Great efforts have been made to promote a more homely environment. Photographs of service users, artwork and framed pictures are on display throughout the home. New leather sofas have been purchased and a new modern kitchen fitted. Floral arrangements and ornaments also contribute to a more pleasant atmosphere. The format of service users files has changed to demonstrate a clearer care planning system. The home has endeavoured to introduce a more personcentred approach. Service users files now contain a detailed individual care plans and daily records demonstrate a regular evaluation of individual needs. Service users have benefited from the part-time Activity Officer being in post. A weekly activity programme is available and service users have enjoyed both one-to-one and group activities. Service users commented there “was lots to do”. Weekly service users meetings are held. These meetings enable service users to contribute to the day-to-day operations of the home. Topics discussed included activities and holidays. Service users also have a dual responsibility with staff to take minutes of the meetings. After these meetings service users meet with the cook to plan their weekly menu. A new risk assessment format has been introduced. All service users have upto-date risk assessments, which address various risks service users face in their daily life. This includes guidelines in reference to service users managing their own medication. Routines within the home are less institutional, whilst respecting the rights and responsibilities of service users. Service users now have free access to staff in the office. An open door policy is in place. The office door is only closed when confidential discussions are being held. Service users wishes in relation to ageing, illness and death is recorded in their individual files. Records also detail where service users have refused to discuss this subject. Adult protection training is in progress. The majority of staff have attended training and others are due to complete this training within the next few months. This includes the domestic staff. Discussions with service users, relatives and staff evidenced that the overall management of the home had improved. New systems had been introduced to promote service users needs. A relative stated “This Manager and Practice Nurse are very good, I cannot praise them enough. It is a different atmosphere, amazing the way the new Manager is turning the place around.” Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thornebury Nursing Home has the necessary documentation and an awareness of service users individual needs. EVIDENCE: Thornebury Nursing Home understands the importance of having sufficient information when choosing a new home. Current and potential service users have access to information, which enables them to decide whether the home can meet their individual needs. The Statement of Purpose and Service User Guide has been recently updated. Both documents reflect current changes. The Acting Manager stated both documents are still being reviewed. The Statement of Purpose sets out the objectives and philosophy of the home. The Statement of Purpose describes the home’s aim “To provide a safe, secure and caring environment that meets the needs and aspirations of the individuals that use our services.” The Service User Guide uses lots of photographs to illustrate topics. Service users were shown taking part in various activities. The Acting Manager stated service users consented to these pictures being used. This document was seen Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 11 as more meaningful as service users, staff and local amenities were reflected throughout. Prospective service users have the opportunity to visit the home and stay on a trial basis. The home has eligibility criteria and service users are only admitted into the home, if their needs can be met. Where needs are unable to be fully met the home evidenced strong partnership working with Health and Social Services, to assist with moving people on. All service users were comfortable in their surroundings and indicated that they were happy living at the home. Service users respected each other’s space and demonstrated a caring attitude to each other. Discussions with service users and observations evidenced they were happy with their care. One service user stated “We are all friends, staff and service users work together.” Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6 - 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users individual needs and choices are generally promoted at Thornebury Nursing Home. More meaningful key working would further enhance the service. EVIDENCE: The format of service users files have changed to demonstrate a clearer care planning system. Service users care plans reflected their assessed and changing needs. The home has endeavoured to introduce a more personcentred approach. Service users files now contain detailed individual care plans and daily records demonstrate a regular evaluation of individual needs. Management and staff understand the importance of service users being supported to take control of their own lives, and to encourage and enable them to exercise their rights and make their own decisions and choices. Service
Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 13 users are supported through the allocation of a key worker. These are assigned staff members who co-ordinate a service users care plan and monitors their progress. Service users must benefit from meeting regularly on a one-to-one basis with their key worker. Service users must be assisted with working on their goals and aspirations. In addition to having the opportunity to express their feelings. Service users meetings give them the opportunity to meet as a group and have an impact on decision making, within the running of the home. Weekly service users meetings are held. These meetings enable service users to contribute to the day-to-day operations of the home. Topics discussed included activities, new furniture, holidays, health and safety. Service users also have a dual responsibility with staff to take minutes of the meetings. It is recommended that the person who records the minutes, prints their name to ensure accountability. Service users are supported to take risks as part of an independent lifestyle. A new risk assessment format has been introduced. All service users have upto- date risk assessments, which address various risks service users face in their daily life. This includes risk assessments and guidelines in reference to service users managing their own medication. The home has a confidentiality policy. Service users’ files were securely stored in the main office. The home evidenced through documentation, discussion and observation that service users are treated with respect and listened to. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 14 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users varied lifestyle needs are individually promoted at Thornebury Nursing Home EVIDENCE: Service users have benefited from the part-time Activity Officer being in post. A weekly activity programme is available and is on display in the entrance area. Service users enjoy both one-to-one and group activities. The home aims to promote the individual’s right to live an ordinary and meaningful life, both in the home and in the community appropriate to their peer group. Service users commented there “was lots to do”. Activities included keep-fit, relaxation, newspaper group, reading group, art and crafts. Service users enjoyed a range of themed parties that have celebrated Bollywood, Mexico, Halloween, Africa and Valentines Day. Religious
Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 15 festivals including Christmas and Eid are also celebrated. The home has also had a Fun Day and barbecues during the warmer weather. Service users have enjoyed a holiday to Butlins. Day trips have included going to Southend, Lakeside, Regent St Christmas Lights, Margate and Epping Forest. The home has a range of board games, a dvd player and a computer is scheduled to be purchased. Staff also felt that service users would benefit from a new karaoke machine. It is recommended that this request is considered. Service users attended various support and day facilities linked to their individual needs. These included a local day centre for people with mental health support needs, a support group for African-Caribbean people and a specialist physiotherapy group. Service users have free access to the local community, with risk assessments in place if necessary. Service users engage in their local community by going shopping, to the bank, cinema, to the pub, park, local theatre, eating out and bowling. Service users are encouraged to become members of the local leisure centre where they go swimming and to the gym. Service users’ files, observation and discussions with service users and staff evidenced that independent living skills are actively encouraged. Service users have individual cooking sessions and if needed are escorted out shopping. Routines within the home are less institutional, whilst respecting the rights and responsibilities of service users. Service users now have free access to staff in the office. An open door policy is in place. The office door is only closed when confidential discussions are being held. Menus were examined and found to be nutritious, balanced and reflected a range of cultures. Service users enjoy traditional White British, Chinese, Italian and halal meals. Service users are offered three meals a day, snacks and drinks. A cooked breakfast is available once a week and fresh fruit is readily available in the kitchen. The home has a cook and homemade snacks and cakes are promoted. Service users regularly meet with the cook to plan their weekly menu. Food supplies and storage was examined. The home has ample supplies of food and good food hygiene practices are maintained. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users personal and health needs are generally promoted. at Thornebury Nursing Home EVIDENCE: Most service users are able to manage their own personal care. Service users receive personal support in the way they prefer and require. Times for getting up/going to bed, baths, meals and other activities are flexible and dependent on service users needs and preferences. Service users are encouraged to take pride in their appearance. Service users choose their own clothes and their overall appearance reflects their individual personality. All service users are registered with a local general practitioner and are supported to attend appointments and to have an annual health check. Service users are supported to access NHS healthcare facilities in the locality. Evidence was seen of the district nurse visiting also visiting the home. Documentation evidenced that service users health is monitored and potential complications and problems are identified and dealt with at an early stage, including prompt referral to an appropriate specialist.
Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 17 Service users are encouraged to pursue a healthy lifestyle. Keep fit is included in the weekly activities. There is a policy and procedure in place for all aspects of medication handling. All medications are administered by registered nurses except for two service users who are responsible for their own medication. Medication is stored in a locked cupboard in the staff office. Medication, medication administration records and the first aid box were examined. The first aid box was adequately stocked and medication administration records were accurately maintained. Staff have training in health care matters. The organisation has a policy, which addresses the ageing, illness and death of a service user. Service users wishes in relation to ageing, illness and death is recorded in their files. Records also detail where service users have refused to discuss this subject. A service user has refused to discuss this subject stating “it’s morbid”. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 - 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Thornebury Nursing Home endeavours to minimise risk and safeguard service users from abuse or harm. EVIDENCE: The organisation has produced a complaints policy and procedure and the Service Users Guide includes a pictorial complaints procedure. The Acting Manager explained concerns were regularly addressed through discussions with service users and relatives. Discussions with service users evidenced that they knew they could approach the management, if there was anything they were not happy with. The complaints book was examined and there has been two complaints since the last Inspection. The first complaint was from a relative and referred to past grievances. The second complaint was in relation to a staff member escorting a service user shopping. These complaints related to incidents under previous management and outcomes were not recorded. The home must ensure complaints are consistently signed off by management and complaint outcomes are recorded. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 19 It was good to see that the home keeps a record of compliments. Two compliments have been received since the last Inspection. The home has been thanked for their charity donation from their Fun Day. Adult Protection, Whistle blowing and Restraint policies and procedures have been produced. Staff had available on the notice board a brief outline of action to take in the event of actual or suspected abuse having taken place. This included informing appropriate agencies including the contact number for the local Commission for Social Care Inspection Office. Adult protection training is in progress. The majority of staff have attended training and others are due to complete this training within the next few months. This includes the domestic staff. Service users financial records were examined and were found to be accurately maintained. Service users are encouraged to save and budget appropriately. Evidence was seen that individuals spent their monies on activities and purchasing items, which enhanced their lifestyles. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Thornebury Nursing Home endeavours to promote a homely environment. General maintenance however must be further addressed. EVIDENCE: Thornebury Nursing Home is located in a close on the borders of Leytonstone and Stratford. Leytonstone High Road with its range of shops, services and amenities is a short walk away. Buses are available from Crownfield Road and Leytonstone High Road. These provide access to Stratford, Walthamstow, Leytonstone and Forest Gate. The nearest underground station is Leyton, on the Central Line. Unrestricted street parking is available outside the home. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 21 Thornebury Nursing Home has a wheelchair accessible ramped entrance area. The home consists of three houses, which have been converted and adapted to provide accommodation in three different but adjoining units. Each unit has personal space and communal space, including lounge areas. There is a main dining room, smoking lounge and a smaller lounge with activity area. A renovation and refurbishment programme is in progress to update facilities in the home. There are plans to decorate and refurnish service user bedrooms, the front entrance, activity room, toilet and bathroom facilities. Service users have a garden with a patio area and garden furniture. Service users additionally have access to the larger garden belonging to the Day Hospital. A range of health facilities are located in this part of Leytonstone. This includes a Day Hospital next door and Langthorne Health Centre. All lounges were found to be warm, clean and cosy. An air ventilator is available in the smoking lounge. Service users moved freely throughout the home and were very comfortable in their surroundings. All lounges had televisions and an individualised atmosphere. Great efforts have been made to promote a more homely environment. Photographs of service users, artwork and framed pictures are on display throughout the home. New leather sofas have been purchased and a new modern kitchen fitted. Floral arrangements and ornaments also contribute to a more pleasant atmosphere. All service users had their own room, which were lockable. Service users explained that they had assisted in choosing the new furniture in the lounge and for their own bedrooms. The following maintenance issues must be addressed. The toilet seats must be secured in the downstairs toilet in House 5 and in the upstairs toilet in House 9. Cobwebs must also be removed in the upstairs toilet in House 9. The chairs in disrepair in the activity room in House 9 must also be replaced. Service users must live in a clean, safe, well-maintained environment. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 - 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Thornebury Nursing Home has adequate staffing. Further improvements however are needed in staff recruitment and supervision practices. EVIDENCE: Staff evidenced that they knew and supported the main aims and values of the home. This included their ways of working, respective roles and responsibilities. Staff demonstrated an awareness of service users’ individual needs. Service users were observed interacting amiably with staff. Staff interacted in an equally, good-natured manner. One service user stated, “We are all friends, staff and service users work together.” Another described staff as “pleasant”. Examination of the staffing rota and observations evidenced that the home was sufficiently staffed to meet the individual and collective needs of service users. There are five registered nurse posts, a range of fulltime and part time support workers. In addition to the Cook, Domestic Worker and part time Activities Officer. There is at least one qualified mental health nurse on duty 24 hours a
Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 23 day. A manager is on-call at all times and a senior manager available in the event of an emergency occurring. Staff sickness and absences are covered by agency staff. Staffing is additionally revised to meet service users specific needs. This included one-to-one staffing when required. The organisation has a staff training programme and a commitment to National Vocational Qualification (NVQ) training. Mandatory staff training includes first aid, food hygiene, health and safety, manual handling and fire safety. Staff receive additional training specific to the service user group. This includes the following: medication, mental health awareness, infection control, information technology (IT), challenging public stigma and breakaway techniques. Staff receive additional self-development training and performance appraisals and performance management. The organisation has a corporate recruitment procedure. Evidence of Criminal Record Bureau (CRB) checks were examined for all staff. CRB disclosure checks were unavailable for three staff members. These are three longstanding staff members. Checks would have been undertaken in 2004/5. This issue was discussed with the Acting Manager, who reported this discrepancy to the Human Resources Department. Evidence of current Criminal Record Bureau (CRB) checks must be available for all staff members. The Acting Manager and qualified nursing staff share responsibility for one-toone supervision. Evidence was seen of staff appraisals, however not all staff received regular individual supervision. The Acting Manager also did not have access to the supervision files maintained by the nursing staff. The Acting Manager was therefore unable to check or evidence that all staff receive formal written supervision. The home must ensure all staff receive regular recorded supervision. The Acting Manager must have access to all staff files to ensure staff are receiving the appropriate support to effectively meet service users needs. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Thornebury Nursing Home is adequately managed, however service users welfare, health and safety must be better promoted. EVIDENCE: Thornebury Nursing Home is owned by Outlook Care, social care organisation. The Manager originally started working at the home six months ago, as an Agency Manager. The Manager has recently been employed on a permanent basis. As they are not yet registered with the Commission for Social Care Inspection, they are referred to as an Acting Manager. The Acting Manager is a Registered Mental Health Nurse, having qualified in 1999. They have worked in a range of nursing settings including acute and day hospitals, secure units and a prison. The Acting Manager stated that their registration application is in progress.
Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 25 The home provides an open, positive and inclusive atmosphere. An Equal Opportunities policy is in place. Discussions with service users, relatives and staff evidenced that the overall management of the home had improved. New systems had been introduced to promote service users needs. A relative stated “This Manager and Practice Nurse are very good, I cannot praise them enough. It is a different atmosphere, amazing the way the new Manager is turning the place around.” Service users daily logs were examined. Records were found to be up-to-date and well maintained. The only issue was in relation to correction fluid being used. To promote accountable and open communication, staff should ensure correction fluid is not used on service users records. Thornebury Nursing Home has the necessary health and safety certificates in place. The home have produced a comprehensive risk assessment, which includes fire and other general risks to staff and service users. Health and safety records were examined. Fridge and freezer temperatures are recorded on a daily basis, weekly fire alarm tests and regular fire drills were undertaken. The main health and safety issue found was in relation to water temperatures. In August 2006 there was no record of cold water temperatures being recorded. Also there was no record of the action taken when hot water temperatures exceed 43 degrees celsius. Water temperature records must be appropriately maintained. The action must be recorded when temperature exceeds recommended safety levels (43 degrees celsius). Examination of the accident records evidenced that accidents were appropriately managed. An incident however was found in the accident book. The home should ensure incidents are appropriately recorded in the correct format. The home has access to professional business and financial advice and has all the necessary insurance cover in place, to enable it to fulfil any loss or legal liabilities. Budgets were examined and the home was seen to have an adequate budget to promote good outcomes for service users. Monthly monitoring visits are carried out and forms part of the quality assurance system of the home. Service development was discussed with the Acting Manager. Evidence was seen that an annual development plan is in progress. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 3 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 X 3 2 3 Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 27 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. 2. Standard YA7 YA22 Regulation 12 (1) 22 Requirement Service users must benefit from meeting regularly on a one-toone basis with their key worker. The home must ensure complaints are consistently signed off by management and complaint outcomes are recorded. The chairs in disrepair in the activity room in House 9 must be replaced. The toilet seats must be secured in the downstairs toilet in House 5 and in the upstairs toilet in House 9. Cobwebs must be removed in the upstairs toilet in House 9. Evidence of current Criminal Record Bureau (CRB) checks must be available for all staff members. The home must ensure all staff receive regular recorded supervision. The Home Manager must have access to all staff supervision files. Water temperature records must be appropriately maintained. Timescale for action 01/04/07 01/04/07 3. 4. YA24 YA27 16 (2) (c) 13 (4) (a) 23 (2) (d) 19 (4) (b) 01/05/07 01/03/07 5. 6. YA30 YA34 01/03/07 01/03/07 7. YA36 18 (2) 01/04/07 8. YA42 13 (4) (a) & (c) 01/03/07 Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 28 The action must be recorded when temperature exceeds recommended safety levels (43 degrees celsius). 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. 4. Refer to Standard YA8 YA14 YA41 YA42 Good Practice Recommendations It is recommended that the person who records the service user meeting minutes, print their name. The purchasing of a new karaoke machine should be considered. It is recommended that staff do not use correction fluid on records. The home should ensure incidents are appropriately recorded in the correct format. Thornebury Nursing Home DS0000065852.V327788.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection East London Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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
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