Inspection on 09/08/06 for Thornfield Care Home

This inspection was carried out on 9th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 26/09/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Thornfield Care Home 8 Milford Road Lymington Hampshire SO41 8DJ Lead Inspector Mrs Pat Trim Key Unannounced Inspection 9th August 2006 09:00 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 Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thornfield Care Home Address 8 Milford Road Lymington Hampshire SO41 8DJ 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) 01590 676191 Mr M A Poordil Mrs S Poordil Mrs S Poordil Care Home 17 Category(ies) of Dementia (17), Dementia - over 65 years of age registration, with number (17), Mental disorder, excluding learning of places disability or dementia (17), Mental Disorder, excluding learning disability or dementia - over 65 years of age (17), Old age, not falling within any other category (17), Physical disability (2), Physical disability over 65 years of age (2) Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users in the categories MD, DE and PD must be at least 55 years of age A maximum of 2 service users in the PD and PD(E) categories may be accommodated at any one time 18th January 2006 Date of last inspection Brief Description of the Service: 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 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 £310.00 to £420.00 per week. Services not covered by the fee include hairdressing, chiropody, personal toiletries, newspapers and outgoing telephone calls. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection carried out by one inspector in 6.5 hours. The key standards were assessed by case tracking three residents and talking with people currently living in the home and their visitors. Time was also spent observing staff practice, talking with two care staff and the registered provider. Some time was spent reviewing documentation and a partial tour of the premises was carried out. Information was also obtained from the pre inspection questionnaire, completed by the registered manager and from comment cards, completed by residents and visitors. The people living in the home had previously expressed their wish to be called residents. This term is therefore used throughout this report. What the service does well: The home feels welcoming and residents said they feel comfortable living there. They said staff provide the care in the way they want it and feel staff treat them with dignity and respect. Comments made included ‘the staff are so gentle, you never hear a cross word’ ‘they look after me really well and everyone is very kind’ and ‘as always, everything is great, the care is excellent.’ ‘Suits me down to the ground – I couldn’t choose one member of staff, they are all the same, very good’. The small staff team have a good knowledge of the individual needs of residents and use this knowledge to provide care in the way the individual likes it, making sure that someone’s personal routine is followed each day. Health care needs are well monitored and good links have been established with health care professionals such as geriatricians, psychiatrists in old age, community psychiatric nurses and community health care teams. There is a good activities programme, which not only provides outside entertainment, but also ensures there is something going on throughout the day for short periods of time. This particularly meets the needs of residents who have dementia and may not like organised activities. Residents commented on how much they liked the gardens, which are well maintained and provide space for residents to walk or just sit and enjoy the sunshine. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 7 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 Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 8 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): 3 – standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have sufficient information to enable them to make an informed choice about whether to move into the home, and detailed pre admission assessments ensure residents may be confident they will only be offered a place if their needs can be met. EVIDENCE: The statement of purpose and service users’ guide gives information about the admission process and states that residents are invited to visit the home prior to admission. It also gives details of what services are included in the fees and what has to be paid for separately. All prospective residents are required to have an assessment of need and for those funded by social services, a copy of the care management assessment is also required. Three residents were case tracked as part of the inspection. All had a detailed assessment of need completed by the registered manager prior to admission. In addition, those funded by social services had a copy of the care management assessment in their files. A further assessment is completed Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 9 during the first few weeks of admission to make sure the information used to prepare the care plan is accurate and up to date. Residents were asked about their experience of moving into the home. One had actively participated in choosing to move to the home and remembered being visited by the registered manager before she moved in. Another said she had not realised she was moving permanently into care, but was pleased she was now living there. She said the registered manager had visited her prior to admission. Those funded by social services had had a review one month after moving in, to decide whether they wished to stay on a permanent basis. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 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, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to receive personal care in the way they like it and can be confident their health care needs will be met. Robust systems and staff training ensure medication is managed safely, although the monitoring of staff practice from time to time would ensure procedures are consistently followed. EVIDENCE: Three care plans were viewed. The assessment completed after admission gave detailed information about what each resident could do and what help they required in all aspects of their personal care. A plan was completed for each identified need, such has mobility problems, or a problem with washing and dressing. Each plan gave detailed information about how the person should receive the help. For example, where the need was for prompting, rather than physical help, the guidance required staff to ensure a resident had a clean towel, soap and hot water in the basin to encourage them to wash. Where mobility was a problem, staff were required to make sure the person had their walking aid with them at all times and had to encourage the person to go for short works throughout the day to promote their mobility. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 11 The use of an individual plan for each aspect of care only where there was an identified problem means that there is no record of the daily routine preferred by each resident. However, staff were able to describe in detail the preferred routines of residents and residents confirmed staff knew and respected their personal preferences. The home is not large so staff have the opportunity to develop relationships with residents and to learn their preferences. Residents felt staff did not hurry them and enabled them to do what they could for themselves. They said staff always asked permission before giving any personal care. Staff were observed asking residents whether they wished for help throughout the day. Information was not always carried forward from assessments to care plans so that care needs could be monitored and reviewed. For example, one assessment identified a resident had very thin skin which could tear easily. The tissue viability assessment identified the risk as low and there was no care plan for skin care. Staff were aware of the risk of tearing or bruising skin, but this information should have been included in the care plan so it could be effectively monitored. Another resident had been admitted from hospital following a fall. The risk assessment identified the risk of falls as low. Staff said the resident had been monitored for a few weeks following admission before the risk assessment was completed and it was identified that there was only a minimal risk, but there was no record of this monitoring. Residents did not remember being involved in completing their care plans, although a number of them would be able to participate in the process. This was discussed with the provider who agreed to look at ways of involving residents or their families more in the care planning process. Daily logs recorded visits by health care professionals. The records of the three residents case tracked showed they had seen a wide range of health care professionals. Pre admission assessments identified where health care professional involvement was required and the records showed this had been followed up. Referrals were made where needs were identified that required the support of health care professionals such as geriatricians, psychologists and community psychiatric nurses. Residents said they were able to see their doctors when they wished and that staff accompanied them to hospital visits if their families were unable to go with them. The provider had recently changed to a new pharmacy and medication was supplied by it in a monitored dosage system. Medication was kept in a locked cabinet and only senior staff were responsible for giving medication. These staff had all completed a training programme. Medication was observed being given out during breakfast. Each resident was given his/her medication in a small pot with a drink. Only one medication was dispensed at a time and the person giving the medication signed the record, Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 12 but was observed completing all records only after giving out all medication. The provider said this was not the guidance given in the in house procedure and confirmed that staff were expected to sign the individual record immediately after each medication had been given. He said he would speak to the member of staff about her practice. The medication remaining in the monitored dosage system matched the completed record for the residents who were case tracked. Staff said they checked the amount of medication received into the home and recorded any discrepancies. A register was kept to record the amount of controlled drugs kept in the home. A record was kept of any unused medication returned to the pharmacist. The home supports residents to manage their own medication if they wish and are safe to do so. A risk assessment is completed to ensure all possible risks are identified and managed. In one instance it was observed that the resident was not keeping her medication where the risk assessment required and this meant there was a possible risk to other residents. This was discussed with the provider who agreed to discuss this with the resident and amend the risk assessment if necessary to reflect the changes. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are offered choices in all aspects of their daily lives and social activities. EVIDENCE: At 8:30 a.m. the majority of residents were having breakfast in the dining room. Some had chosen not to get dressed, as they said they preferred to get dressed after breakfast or they were going to have a bath later that morning and did not want to get dressed twice. Some residents had breakfast in their rooms. All residents said they could choose where they had their meals, what time they got up and went to bed and where they spent their day. Residents moved freely around the home, and many walked round the gardens, either alone, or accompanied by staff. Residents said they felt they were able to make choices about all aspects of their daily living. Some commented that they thought the television in the main lounge was on too much, but said they could move into the conservatory or their own room if they wanted to get away from it. Others said they enjoyed reading, knitting or doing quizzes whilst sitting in the lounge. Staff made sure they had what they needed to do these activities, such as pens, paper, knitting needles and patterns or books and magazines. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 14 The provider said staff are expected to spend time with residents providing social and emotional support. They were seen doing this throughout the day by sitting with residents doing puzzles, chatting, playing ball and doing quizzes. They spent time walking round the garden with them. The home has a volunteer whose role is solely to spend time providing mental stimulation for residents. Activities for residents who have dementia are provided on a one to one basis for short periods of time to enable them to fully participate in things they like doing. Outside entertainers are regularly provided and include an exercise class and singers. Residents said regular trips out were arranged, using a local taxi. They chose where they should go and three residents went out on the afternoon of the inspection. Not all residents wanted to go out, but those that did, said how much they enjoyed these trips. Records are kept of those who participate in each activity and those who choose not to. This information is used to review what is offered to make sure all residents to have the opportunity to participate in something they enjoy. Several residents said being able to practice their religion was important to them and care plans identified how they were supported to be able to do this. Ministers from local churches visit those residents who wish it on a regular basis. Family and friends are able to visit whenever they wish and residents said they felt their visitors were always made welcome. The menu for the day is displayed on a notice board in the dining room and on small cards on individual tables. Residents said they enjoyed the meals that were provided and felt they were offered choice. They were offered drinks and snacks throughout the day. Residents are able to have their individual choices. For example, one resident, recently admitted, said she preferred brown bread to white and liked to have yoghurt for pudding. The provider purchases these items so that she is able to have them. The home had employed a cook who had recently left, so staff were currently cooking meals, but the provider said he was interviewing for a replacement. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A robust complaints procedure enables residents to raise issues with the management, be confident their complaints will be investigated and that they will be informed of the outcome. Robust procedures and staff training protect residents from the risk of abuse. EVIDENCE: Residents said they felt able to raise issues with the provider and were confident they would be addressed, although everyone said they had not had any reason to complain. The home has a complaints procedure, which gives information about how a complaint will be handled and each resident has a copy. Residents may raise issues directly with the provider or, if they prefer, they can complete a form anonymously and put it in a box in the hallway. Copies of the form are kept in residents’ rooms and throughout the home. The complaints log originally provided for residents’ complaints has been used to record staff complaints. It was suggested that a separate book should be kept for residents and their families so their concerns and the outcomes of any investigations could be kept confidential. The home had a policy and procedure for the protection of vulnerable adults. Staff had attended training and were able to demonstrate they were aware of their responsibility to report any incident of abuse. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 16 The provider confirmed the home’s policy of not holding any money on behalf of residents had not changed since the last inspection. Residents managed their own money and paid directly for services such as hair dressing or chiropody or their families paid a monthly invoice on their behalf. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 17 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to live in a comfortable, clean and safe environment that meets their needs and that they like. EVIDENCE: Residents said they were very happy with their environment and that it had a homely feel to it. They thought the home was kept clean and that the furnishings were comfortable. On the day of the inspection the home was clean and there were no unpleasant smells. There is a cleaning schedule to ensure all areas of the home are cleaned regularly. Hampshire fire and rescue service visited last year and found fire safety arrangements satisfactory. The environmental health officer visited in January 2006 and recommended that the home update its food storage system. This has been done. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 18 The provider explained that the handy man, employed by the home, carries out routine maintenance, as required. The need to redecorate is monitored through the monthly audit and planned in through the year. The gardens are well maintained and secure. Residents said how much they enjoyed walking or sitting in them. Care staff manage the laundry as part of their duties. There is a policy and procedure for the management of soiled linen and laundry facilities that are able to deal with it. Staff are provided with disposable gloves and aprons. Some staff have attended infection control training and the provider said further training will be arranged for those who have not. The home has a contract for the disposal of clinical waste. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 19 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, 28, 29 and 30 Residents are supported by well trained staff in sufficient numbers to meet their needs. A robust employment procedure ensures residents are protected EVIDENCE: Residents felt there were sufficient staff to meet their needs and said that calls for assistance were answered promptly. Staff were observed answering call bells promptly throughout the day. Staff said they thought there were sufficient staff to support current residents. The home has a staff rota and residents know what staff are on duty as a list is completed every day on the board in the lounge. On the day of the inspection the deputy manager and two staff were working from 8 a.m. to 8 p.m. This was the normal staffing level provided in the home. One of the providers was also working as the registered manager and the volunteer was working with residents for part of the day. There are two waking staff on duty at night. Two new staff were case tracked to assess the recruitment process and to monitor compliance with a requirement made at the last inspection. Both staff had completed an application form, had a formal interview and provided two references. Two references were on file for each applicant, one of which was from their last employer. Both staff had a Protection of Vulnerable Adults (POVA) check completed prior to their employment and a Criminal Records Bureau (CRB) disclosure applied for. One of these had been returned. Both staff had received an offer of employment and had a contract. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 20 The provider said that staff were expected to complete an induction programme and a record of this was found in staff files. It was completed over a number of weeks and included shadowing experienced staff, reading policies, procedures and care plans, and completing training courses. Staff were not given a workbook to complete and the provider was advised to refer to the Skills for Care website for guidance to ensure the induction programme complied with the requirements for care staff. Mr. Poordil said all new staff were given a copy of the code of conduct. Staff spoken with said they felt supported by the provider to develop their skills and attend training. 60 of staff have achieved National Vocational Qualification (NVQ) 2. More are beginning it and others are going on to complete NVQ3. Staff said they had completed basic training such as moving and handling, first aid and food hygiene as well as service specific, such as dementia, continence care and adult protection training. Staff files contained certificates to evidence this. A training matrix was used to identify what training staff needed and to monitor when refresher courses were required. Staff said they received regular supervision and the provider confirmed this was given by him, or by the registered manager. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 21 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, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager of the home ensures that residentss and their families are able to give feedback about the service they receive. There are systems to make sure health and safety issues are addressed and residents are protected EVIDENCE: Residents said they thought the home was well managed by the provider and registered manager. The registered manager has a nursing qualification and has completed a registered manager’s award. Although Mrs. Poordil is the registered manager, she and her partner share the day to day management of the home. Residents’ meetings are occasionally held and minutes are taken. There was evidence that issues raised at these meetings are acted upon. For example, at the last meeting residents asked for more outings, a supply of films they liked Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 22 to be available and for the opportunity to try a particular food. All these requests had been acted upon. The provider also sends questionnaires to residents and their families. Mr. Poordil said these are looked at and any issues acted upon, but they do not generate a report that is available to residents. He was advised to look at ways of sharing the information obtained from questionnaires with the people who complete them. Regular staff meetings are held and staff also receive individual supervision enables them to discuss any issues and review practice. The providers complete a monthly internal audit of the service, which looks at resident satisfaction, staff issues and the environment. Matrixes are used to identify when equipment needs to be tested or serviced and to identify staff training needs. Copies of inspection reports are kept in the office so that anyone may see them if they wish. As stated in the complaints section of this report, the providers do not hold any money on behalf of residents. Any expenses incurred by the resident are either paid for directly by them or Mr. And Mrs. Poordil send an invoice to the person responsible for managing the resident’s money. Receipts are kept of any expenditure invoiced in this way. A number of certificates and maintenance contracts were seen during the course of the inspection. These, together with information provided in the pre inspection questionnaire, evidence that the home is maintained to protect the health and safety of residents. Basic training needs are identified during induction and arrangements made for staff to attend training such as food hygiene, first aid and moving and handling. Training needs are monitored to ensure staff are able to attend refresher courses when required. Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Thornfield Care Home DS0000011794.V303043.R01.S.doc Version 5.2 Page 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!