Inspection on 26/09/08 for Thornfield Care Home

This inspection was carried out on 26th September 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Thornfield Care Home 09/08/06

Thornfield Care Home 18/01/06

Thornfield Care Home 01/02/05

Thornfield Care Home 14/07/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Thornfield Care Home 8 Milford Road Lymington Hampshire SO41 8DJ     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: Michelle Presdee     Date: 2 6 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 26 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 26 Information about the care home Name of care home: Address: Thornfield Care Home 8 Milford Road Lymington Hampshire SO41 8DJ 01590676191 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs S Poordil Type of registration: Number of places registered: Mrs S Poordil,Mr M A Poordil care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: A maximum of 2 service users in the PD and PD(E) categories may be accommodated at any one time Service users in the categories MD, DE and PD must be at least 55 years of age Date of last inspection Brief description of the care home Thornfields provides care and accommodation for 17 residents who are older persons or older persons with dementia. The service is also registered to accommodate service users over the age of 55 years who have dementia or mental health problems and 2 service users over the age of 55 years who have a physical disability. The home is Care Homes for Older People Page 4 of 26 Over 65 17 17 17 2 17 17 0 2 Brief description of the care home privately owned by Mr. and Mrs. Poordil. Mrs. Poordil is the registered manager, although the day to day running of the home is shared between them. The building is a large family home that has been extended to provide bedrooms on 2 floors. There are 9 single and 4 shared rooms. 7 of these have en suite facilities. Communal space comprises a large lounge diner and conservatory. There is a stair lift to enable service users access to both floors. The home has car parking space at the front of the property and a large enclosed garden and patio area to the rear. Thornfields is situated on a busy main road, close to local shops, amenities and public transport. Lymington is a short distance by car. The current fees for the service as recorded in the pre inspection questionnaire are £395.00 to £430.00 per week. Services not covered by the fee include hairdressing, chiropody, personal toiletries, newspapers and outgoing telephone calls. Care Homes for Older People Page 5 of 26 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: During this inspection The Commission (we) were assisted by the manager of the home and members of the staff team. Time was spent observing and talking to people who lived in the home. Staff members were spoken with as were two visitors to the home. All feedback was of a positive nature. Surveys were received from people living in the home, staff members and health professionals. The home sent us their Annual assurance Assessment (AQAA) back on time, which highlighted improvements the home had improved on and areas where they could further improve. Care Homes for Older People Page 6 of 26 A tour of the home including all communal areas, the kitchen and five bedrooms randomly chosen was taken on the day. Paperwork including assessments, service user plans, menus, staffing records and health and safety checks were seen. All this information has helped form the judgements included in this report. 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 26 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 26 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 have full and accurate assessments of their needs and are confident the home can support them. Evidence: In the AQAA we were advised service users are encouraged to visit the home and to ask any questions they may have. They are given a brochure to take away with information on the home. A pre assessment is done in a prospective clients own environment to ensure the home is able to meet their needs. The assessments of three people who were observed at length were looked at. It was noted these detailed good clear information and had also included the views of the person concerned. A personal profile had been been developed and family members had been included in this process. Assessments included information on a range of areas including mental health, physical abilities, behaviour, manual handling and Care Homes for Older People Page 10 of 26 Evidence: details of all health concerns. Two people living in the home who had completed surveys confirmed they had to come to look at the home before moving in. One person wrote We came as a family and I moved in the next day. Another wrote My family made inquiries, I am extremely fortunate to be here we all get along very well together. Two visitors were spoken with, both were very happy with the home. They both stated they had helped their relative choose the home and felt it had lived up to what they were expecting. Comments included Wonderful, fantastic and lovely atmosphere. The home does not provide intermediate care. Care Homes for Older People Page 11 of 26 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. All people have a comprehensive plan of care to meet their health, personal and social care needs. Medication is managed in a safe way. Peoples right to privacy is respected. Evidence: The care plans belonging to the three assessments were viewed. It was noted these were all of the same good standard. Information had been recorded in a number of different areas, which was clear and up to date. Risk assessments where necessary had been added for example pressure sore risk assessments, falls risk assessments had been completed. Care plans were specific to each person, for example in one it stated the person can become aggressive. The care plan then went on to state what the aim was and how this should be achieved. Clear instructions were written down for staff. When talking to a staff member they were aware of the details of the care plan and the associated risks and how this behaviour should be managed. Care plans had been reviewed on a regular basis. Care Homes for Older People Page 12 of 26 Evidence: Care plans seen gave clear details of all health needs and visits. Evidence was seen that an optician, dentist, community psychiatrist nurse chiropodist and district nurse visit the home. Details are recorded in the care plan. Four surveys were received from health professionals all stated the individuals health care needs are met by the home. All surveys received from people living in the home stated they always received the medical support they needed. The home has a clear medication policy that staff spoken to were aware of it. On arrival to the home the district nurse also called for a routine appointment. At this time one person was given controlled medication. It was noted the correct procedure was followed and medication was stored correctly. Written records were recorded accurately and the person concerned was treated in a respectful manner and her privacy maintained. All surveys received from health professionals stated the care service always respects an individuals privacy and dignity. The medication procedure was watched when medication was given after lunch. It was found the correct procedure was followed. It was noted for medication which was prescribed to give as necessary, people were asked if they were in pain and medication was given due to the response. All records matched the stock held and records had been correctly recorded. It was noted in two peoples care plans instructions were detailed on crushing a medication. The manager advised the GP had been consulted and agreed this was suitable for the particular medication and for the person concerned. However written confirmation could not be found from the GP and it was agreed confirmation would be sought from the GP. Privacy and dignity were promoted through out the home. People were asked in a discrete manner if they wished to use the toilet. At meal times assistance was offered in an unobstrusive manner. Double rooms had screens. Two relatives confirmed they could always see their relative in private. Both confirmed their relative was always wearing their own clothes. One relative stated, The staff have a wonderful manner they are discreet and very reassuring. Care Homes for Older People Page 13 of 26 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. A range of activites are offered to people but care must be taken to ensure some people are not left out of activities and become isolated. People keep in touch with family and friends. People enjoy their meals at a time and place to suit them. Evidence: In the AQAA we were advised, Residents are offered choices in aspects of daily and social activities; IE when and where they have their meals, what time they get up and went to bed, where they spend their day. We do various indoor activities to meet our clients needs based on the individuals own preference. On the day it was clear people living in the home have freedom of movement and can spend their time how they want. Some people spent time reading newspapers and magazines. Others were knitting and one person went for a walk down the road. It was noted whilst observing the residents two people did not engage in any social activity and also were not spoken to by care staff in the room. One staff member in a survey did state in What could the service do better? More entertainment for those with short interest span. This was brought to the managers attention who did state she would ensure staff take an interest in all residents social activities. Later in the day a Care Homes for Older People Page 14 of 26 Evidence: staff member was seen to be spending time with one of the identified people. In surveys from people who use the service the response to, Are there activities arranged by the home that you can take part in? received a mixed response. One person put always two responded with usually and one person put sometimes. Two visitors spoken with confirmed they could call at any time and were aways made welcome. On the day they were offered tea and coffee and they stated this was normal practice. Both confirmed they could go to their relatives room if they wished to have a private conversation. People living in the home spoke of their enjoyment of going out with relatives and friends. We were advised by the manager of the home ministers from the local churches visit regularly and the mobile library visits the home. The home has a rotating four week menu, the meals of the day are displayed on a white board in the home. The home has a member of staff who is the designated cook for the home. She felt the home offered good quality meals, which residents had been consulted on. She confirmed fresh vegetables are used at most lunch time meals and cakes and puddings are usually home baked. For lunch fish, chips and peas were served or fish in sauce with mashed potatoes. For pudding sponge and custard was served. Meals were served at the dining tables, for those who did not want to move a table was placed in front of them and the meals were served there. It was noted assistance was given in a discreet manner. People spoken to stated they enjoyed the food and looked forward to the meals. One regular visitor stated the food was wonderful. Care Homes for Older People Page 15 of 26 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. People know how to complain and have confidence their concerns will be listened and acted upon. The home safeguards people from abuse and neglect. Evidence: In the AQAA we were advised We have a complaint and comment card in each individuals room. We have a complaint procedure on display on the notice board. People living in the home stated they would be very comfortable speaking to the manager or staff members if they were unhappy. All people living in the home who had completed a survey stated they knew how to make a complaint. One person stated, This situation has not arisen and is very unlikely to occur!. Two visitors spoken with both stated if they had any concerns or complaints they would discuss with the manager. Both stated they would feel very comfortable discussing any issues with the manager and had confidence she would be able to sort out any concerns or complaints. We were advised the home has received no complaints since the last inspection. The manager advised us the home has an adult protection procedure, which incorporates the local authority procedure. Staff have received training in this area and are aware of the different types of abuse. The manager stated she is considering doing Train the Trainer in this area so she can cascade this information to all care staff. Care Homes for Older People Page 16 of 26 Care Homes for Older People Page 17 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well and safe maintained home that is clean, homely and hygienic. Evidence: In the AQAA we were advised We ensure the home is kept clean, comfortable, homely and secure. All electrical equipments are maintained and service regularly. Specialist equipments are in place to help service users. On the day all areas of the home were seen and five bedroom were randomly chosen to look into. All areas seen were clean and decorated to a reasonable standard. People living in the home had personalized their own rooms and some had brought items of their own furniture. All areas were safe with radiators and water pipes not being exposed. All windows where appropriate had restrictors fitted and the temperature of the hot water was regulated. No unpleasant smells were detected around the home. People spoken to on the day stated the home was always clean and warm. People stated their rooms were kept clean and their laundry was well maintained. All people living in the home who completed a survey felt the home was always fresh and clean. One resident wrote, My room is very nice with a lovely view of big trees from the window. We also have a very nice garden to look at from the lounge. Care Homes for Older People Page 18 of 26 Evidence: Visitors spoken to confirmed the home is aways kept clean. Both commented on the lovely atmosphere and said there was a calming atmosphere. Care Homes for Older People Page 19 of 26 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. People receive good support from competent and trained staff. People have confidence in them and know appropriate checks have been made to ensure they remain safe and not at risk. Evidence: In the AQAA we were advised, We aim to provide staffing levels appropriate to the needs and numbers of residents. All our staff do a thorough recruitment procedure, checks and Protection Of Vulnerable Adults check. On the morning of the inspection three members of staff were on duty, one of these members of staff was also covering the kitchen and preparing lunch. We were advised this was very rare and there is normally three members of care staff on duty through out the day. We were advised one member of staff had phoned in on the day as she was sick. All members of staff confirmed there is always enough staff on duty to meet the needs of the people living in the home. All surveys received from those living in the home stated there was always enough staff available when they needed them. One resident wrote the staff are very thoughtful and caring and I couldnt wish for more. This view was echoed by visitors to the home who made statements which included perfect care, lovely staff. Care Homes for Older People Page 20 of 26 Evidence: The home has a small staff group and just under 50 have achieved a National Vocational Qualification Level 2. The manager is aware of this and stated four more members of staff will have registered to start to study for this qualification in the next few months. The staffing records of the last two members of staff to start work in the home were viewed. It was found these contained all the necessary information and all the appropriate checks had been undertaken. The manager stated she was aware of the need to ensure appropriate checks and references are undertaken before staff members can start work in the home. Evidence on staff files was seen that staff had under gone an induction programme with skills for care. Staff spoken to felt their induction process had been good and given them a good introduction to the homes philosophy and policies. Surveys received from staff members all felt their induction covered everything they needed to know. Training records were maintained for all staff members, giving a clear picture of who had undertaken what training and who needed particular training. The manager is considering undertaking train the trainer in numerous areas so she can then cascade this training to staff members. The home currently uses a company for training which mainly uses postal correspondence and videos. The use of this for moving and handling was discussed and the manager is going to seek from the company if this is acceptable on its own or if a practical session is needed. Staff on the day stated they felt the training met their needs and all surveys received from staff indicated they felt their training was relevant, up to date and helped them understand the individual needs of the people in the home. Care Homes for Older People Page 21 of 26 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. People have confidence in the home because it is well managed. The environment is safe for people and appropriate health and safety practices are carried out. Evidence: In the AQAA we were advised We work towards ensuring there is a good interaction and relationship between the management, staff and service users. On the day it was clear there is a good relationship between the manager, staff, people living in the home and their relatives. All comments were positive about the manager of the home. Staff had confidence in her and felt she had an open style of management. It was clear from observations she had a good relationship with the people living in the home. Visitors spoke of her calming influence and her approachable manner. The manager has completed a registered managers award and has a nursing qualification. Care Homes for Older People Page 22 of 26 Evidence: It was clear from observations and discussions on the day the home is run in the best interests of the people who live in the home. Resident meetings are held on a regular basis and the views of residents are recorded. The home has recently started its own quality monitoring system. This has involved sending questionnaires out to relatives, reisdents and professionals visiting the service. The home does not become involved in managing any of the residents finances. Records were available demonstrating staff receive regular supervision sessions. Staff spoken to confirmed they had regular supervision with their manager, which they felt was beneficial to them and people living in the home. From information in the AQAA and from records seen on the day it was clear the registered manager ensures the health and safety of people living in the home and staff. All equipment has the necessary checks and inspections. The fire log book demonstrated all the necessary checks were being undertaken within the timescales, fire equipment and the fire alarm were serviced on a regular baisis. Staff received fire training from an external trainer. Gloves and aprons were seen around the home and were worn by staff. The cook was aware of food and safety legislation. Care Homes for Older People Page 23 of 26 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 24 of 26 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 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 Care Homes for Older People Page 25 of 26 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 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!