Inspection on 03/04/07 for Thornfield Care Home [Seaton]

This inspection was carried out on 3rd April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 [Seaton] 28/01/09

Thornfield Care Home [Seaton] 04/03/08

Thornfield Care Home [Seaton] 03/10/07

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Thornfield Care Home Thornfield 87 Scalwell Lane Seaton Devon EX12 2ST Lead Inspector Teresa Anderson Unannounced Key Inspection 3rd April 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Thornfield Care Home DS0000068262.V317143.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 DS0000068262.V317143.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thornfield Care Home Address Thornfield 87 Scalwell Lane Seaton Devon EX12 2ST 01297 20039 01297 625979 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) Cannon Care Homes Limited Mrs Alison Diane Tomkinson Care Home 38 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (38), Old age, not falling within any other of places category (38), Physical disability over 65 years of age (38) Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection This service has a new provider since the last inspection Brief Description of the Service: Thornfield is a care home that provides care and accommodation for up to 38 residents with needs relating to old age and/or dementia. It is situated on the outskirts of Seaton, in a quiet residential area within driving distance of the town and seafront. The home is a large older style house, which has been converted and extended over the years. There are currently two areas within the building where people are cared for. One area includes a lounge, small dining area and conservatory. The other area has two linked sitting areas and a dining room. Residents who spend their days in this second area have their access to the rest of the home restricted by a keypad system. Bedrooms are situated on the ground and first floors. The majority are for single use and some have ensuite facilities. A staircase and a small passenger lift link floors. Outside the home there is parking on the road outside and a small garden to the rear. The fees range from £360.00 - £460.00 per week. Fees do not include items such as taxi fares and the cost of newspapers or toiletries. Further information about this home is available direct from the home. Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the normal programme of inspection. The site visit began at 10.00am and finished at 6.30pm. During that time the inspector spent time talking with residents, with staff, a visitor and the manager and deputy. As the majority of residents living at this home have dementia type illnesses and cannot communicate directly, a large amount of time was spent looking closely at the care and accommodation offered to four of these residents. Using the Short Observational Framework for Inspection (SOFI) engagement, well being and staff interactions were observed over a period of one hour. Care plans were read and the inspector spoke with staff about how they meet the care and individual needs of residents. This ‘case tracking’ system helps to provide a general understanding of the quality of services delivered, and the quality of life experienced by, the people living here. Prior to the site visit surveys, asking for comments and feedback, were sent to 16 residents and 7 were returned; to 12 members of staff and 4 were returned; to a variety of health and social care professionals and 2 were returned. Their comments and opinions are included in the main body of this report. In addition the manager completed a pre-inspection questionnaire which including information on issues such as training, policies and procedures, staffing levels and meals. What the service does well: Each person who comes to live at this home has their needs assessed prior to admission to ensure that the home can meet their needs. All residents have a contract and one person describes these as ‘plain and uncomplicated’. Healthcare needs are generally well met with evidence of good health being promoted. Health and social care staff who visit the home say that staff ask for advice and put this into practice. The meals served here are cooked on the premises and residents say they are ‘good’ and ‘wholesome’. There is a choice of menu and other alternatives are offered if needed. Hot and cold drinks are available throughout the day. Complaints received from relatives are dealt with efficiently and the manager views this system positively as a way of improving the quality of the services provided. Residents are protected from abuse through the training of staff in safeguarding vulnerable adults and their monies are well managed through an auditable system. Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 6 Staff receive mandatory training, some specialist training and 50 of the care staff hold a National Vocational Qualification in Care at Level 2 or above. The manager is well qualified and experienced and is supported by a caring staff team. What has improved since the last inspection? What they could do better: Although each person living here has a plan of care these do not form the basis of person centred and individualised care, and some staff have not yet fully developed their skills in relation to caring for people with dementia. In addition some private information is not being kept confidential. In some cases these practise have resulted in the dignity of some residents not always being respected and in not enough attention being paid to how people with dementia might be supported to make choices in their lives. In addition, some residents have behaviours which challenge this service. These may be an expression of ‘complaint’ but are not judged by staff as such. The home is effectively divided into two distinct areas and whilst one side is very homely, the other is not. The dining room in this area can become very noisy when people are eating, meaning that people cannot fully enjoy their meals. In addition movements out of this second area are controlled by a key pad system which residents are not given access to. This means that residents do not all have access to their bedrooms and the reasons behind this are not clear. There have been many improvements in the amount and variety of activities on offer to residents. This is co-ordinated by an activities co-ordinator who works each afternoon. However, activities are largely aimed at the more able residents and many of those with dementia remain unoccupied. Although the home is generally well managed, cared for and is safe there are some areas that need attention. The fire door at the top of the stairs does not close properly, practice in relation to managing falls may be increasing the risk of injury for one person, the call bell in one of the lounges does not work and one member of staff wore flip flops throughout this inspection. This puts herself, staff and residents at risk. In addition medication is not being managed safely and recruitment practices and staff knowledge in relation to reporting abuse are not fully safeguarding residents. The owner is not carrying out regular unannounced visits in order that he can make a judgement about the quality of services and care delivered at this home, and so that he can take appropriate actions where necessary. Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 7 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. Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. People who wish to come and live at this home have their needs assessed to ensure that the home can meet these needs This home does not provide intermediate care This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the surveys returned by residents (or their supporters) all say that they had enough information about the home before they moved in and all say they have contracts. One person commented they were easy to understand. Prior to each person moving into the home, the manager meets with them and, where possible, their supporters. She uses a standard format to determine and record basic needs. In addition, and where social services are involved, she Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 10 obtains a copy of any assessment and care planning information available from them to ensure that comprehensive information is available. Staff say they have some information about new residents before they meet them, although they are not always introduced to them. Care plan recordings and discussions with staff suggest that some staff do not understand that moving into a care home can be a significant life event, especially for those with communication problems. In addition some important information collected during the assessment is not always used to help support the new resident on admission (see under ‘Health and Personal Care’). Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9, 9 and 10. Quality in this outcome area is adequate. People who live here generally have their healthcare needs met. However the way that care is planned and delivered is not ensuring that residents get a consistently high standard of individualised care. Some practises in relation to handling medications are putting some residents at risk. Staff generally ensure that peoples right to privacy is upheld, but not all staff always promote the dignity of those people living here who cannot do this for themselves. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person who comes to live here has a plan of care and these are easily accessible by staff. Four were looked at in depth. Care plans demonstrate that in general proactive management of healthcare needs takes place. For example residents are registered with a GP of their ( or Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 12 their families) choice and are attended by chiropodists, dentists and opticians as necessary. The home has a low incidence of pressure sores and equipment for the prevention of pressure sores is in use. In surveys healthcare professionals state that the home always or usually seeks advice and acts upon it and that healthcare needs are usually met. The system for planning care is well organised and provides the basis for easy access to information relating to each resident. The system includes identifying individual needs, setting a goal for intervention and reviewing the actions taken in order to assess their effectiveness. Reading through the care plans shows that these are usually written by the manager or deputy and staff contribute by writing in the ‘event history’. However important information collecting during assessment is not always used to help support the new resident. For example, one assessment indicates that the resident has a particular communication problem but this information has not been used to inform the plan of care and staff spoken with were unaware that this person has this condition. Also, information about the need for one resident to have privacy and their preference of place to eat had not been noted in the care plan or used to help support this resident and to provide care in a personalised way. In addition, staff report they have not looked at care plans for a long time, separate records are kept in relation to ‘toilet records’ and some care planning is carried out on the white board that is placed in a public area. The records of one resident for example, shows that this person has a health problem that is likely, at times, to cause significant pain and discomfort. This was first noted in March 2006. The daily event notes show that different staff are managing this quite differently. One entry indicates that this condition has to become ‘severe’ before a doctor is called to prescribe treatment. Another entry indicates that the doctor should be called immediately. Although these entries show that this person has a specific and individual need, a goal for intervention has not been set which would give staff guidance on how this condition should be managed consistently and in the best interests of the resident. No review has taken place. When the inspector asked staff what information was important to know about this resident, they did not include this condition. Another care plan contains information in the daily event records about one resident’s (unintentional and unknown) tendency to upset another resident and to be aggressive to others. Records show that this has resulted in some upsetting scenes and in two residents being injured. Staff notes state that a referral was to be made to the Community Psychiatric Nurse (CPN). Although this was done, correct procedure was not followed and the referral was not accepted. As a consequence the resident has not been seen by a CPN and no Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 13 follow up action has been taken. Whilst the notes state that the CPN has been spoken with about how to manage this aggressive behaviour once it has occurred, this advice has not been written down or shared with staff. It does not therefore meaningfully contribute to a plan of care that would prevent or manage this behaviour. The daily event notes show that this person still gets agitated under certain conditions. Staff spoken with are aware of these conditions, however they do not take actions to prevent them, only to act after the event. Another care plan shows that one resident is falling quite frequently and a falls risk assessment has been undertaken. However, whilst care notes show that appropriate actions are taken after each fall, a plan to prevent further falls and minimise injury has not been recorded and reviews are not taking place. The daily event notes do state that a mattress should be placed on the floor next to this person’s bed so that if they do fall out of bed the risk of injury will be reduced. Some staff are aware that this intervention is to take place, others are not. In addition, some staff are increasing the risk of injury by placing a pillow under the resident’s mattress to prevent them rolling out of bed. When asked however, staff said that this person does not roll out of bed but they climb out, usually in search of the toilet. The placement of the pillow creates a situation whereby the risk of this person injuring themselves has been increased. This information was shared with the manager on the day of the inspection. The general wellbeing of those residents with dementia who live at this home was judged using an observational tool. This shows that during a mid morning period, residents spent over half of their time sleeping. During the remaining time residents were awake with no signs of either positive or negative moods, that is in a passive state, and appeared bored. Medication is on the whole managed well at this home. A recent change over to another chemist was highlighted as the reason why staff are not accurately recording the medication received into the home. Other recordings were generally up to date and all medications seen were kept safely and securely. However, one hand written entry on a medication chart relating to a controlled drug, despite being checked and signed by a second person, was not written as the doctor had originally prescribed it. In addition, this same entry had been subsequently changed by someone other than the doctor, and had the effect of reducing the dose of a pain-killing drug. The manager did not know who had done this. When asked, there was confusion amongst different staff as to whether this person was experiencing pain. In addition prescribed ointments are not being signed as being applied. In surveys healthcare professionals say that staff usually respect residents’ privacy and dignity and during the inspection staff were observed ensuring that care was delivered in private. During most of the site visit staff were observed promoting the dignity of residents. However, whilst some staff very quietly and Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 14 discreetly asked residents if they would like to go to the toilet, others were less discreet. On one occasion just before lunch, one resident was clearly affronted when asked loudly if they wished to go to the toilet. They refused, although the inspector had seen that they had not been all morning. In addition, just before lunch staff were seen putting plastic aprons on to residents without explaining to them what they were doing. It was observed that whilst some residents needed protection from spilled foods, other did not. The general use of plastic aprons is not the most dignified solution to this problem. Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. The people who live here can be assured that they will have free and easy access to their visitors. However, despite improvements they cannot yet be assured that their interests will be taken into account and used to help them to engage with the world. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the early days of admission the manager works very hard to gain important information about the people who live here. In some cases this includes a person’s life history, interests, family details and information about the person’s spiritual needs. This information is not generally used in planning, delivering or meeting social care needs. Some staff had some awareness of who the resident was before they came to live at the home but others did not. Those that did, did not see this as important information to share with a carer who would be looking after that person. Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 16 One care plan states one of the aims of one resident’s care is to maintain their ‘sociability through communication’. The plan did not give staff guidance on how this might be achieved. The care plan of another resident states that this person is profoundly deaf. Staff told the inspector that they write messages down to help communication. However, paper was not kept near to this resident on the day of inspection and the inspector did not see any staff using this method of communication to help them communicate with this resident. Residents were observed sitting for long periods of time on their own. Staff interacted with the four residents observed over a period of one hour on three occasions. All occasions were associated with a task such as drinking tea or going to the toilet. The inspector also observed, during the observational period and at other times during the inspection, that staff rarely made eye contact with residents or touched them unless they were taking them somewhere or adjusting their clothing. Whilst these interactions did not show any real warmth, neither did they show any ill intent. Some residents flicked through magazines that are easily accessible in the lounge where the observation took place and very occasionally one of the residents looked at the TV which was on all day. One resident was given a child’s book to look at which is age inappropriate and which the resident did not show any interest in. There were no magazines or books at hand that the men in the room might have enjoyed. The home has recently appointed an activities co-ordinator who works with residents each afternoon. She has helped to increase the number of activities taking place both within and outside the home. These include a weekly music session, bingo, monthly communion and walks on the lane outside the home. More able residents have attended the theatre, the pantomime and have had trips out to places like the seafront. In surveys residents say (in the main) that there are always or usually activities arranged by the home that they can join in with. One respondent said that their relative could not join in because they found the noise upsetting. On the day of the inspection the activities co-ordinator was helping four residents to decorate Easter bonnets, and two other residents chose to look on. She skilfully used this activity to talk with residents about other events and situations in their lives, and to generally generate conversation and interaction. When a gentleman came to join the group he was welcomed and assisted to join in. A carer also joined this group and she too helped to make this a really sociable and enjoyable event. Other residents were sitting in the lounges mostly unoccupied. Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 17 Visitors are free to visit at times that suit them and the resident. One visitor told the inspector that they come when they like and that staff are always welcoming and helpful. The food is described by residents as ‘tasty’, ‘good’ and ‘wholesome’. It is cooked on the premises. Vegetarian alternatives are offered as part of the menu, and other alternatives can be requested by residents or on their behalf if needed. Hot and cold drinks are offered at regular intervals throughout the day. Meals are mainly served in two dining rooms. One dining room has tables which are dressed and where the ambience is quiet, restful and sociable. The other dining room is noisy and bustling. Residents wear plastic aprons and some are stood over as they eat. One resident who sits in the middle of this activity is described as being agitated by noise. The care plans of two other residents state that they will eat better or would prefer to eat in a quiet environment. These needs and preferences were not taken into account as they were eating in the noisier of the two rooms. It was observed that other preferences may not be taken into account. For example, some care plans gave information in relation to preferred going to bed and getting up times. Staff were not always aware of these. Concerns had been raised about a resident who was always very particular about their appearance not wearing their own clothes. A resident who staff know does not like being wet and who is not able to keep themselves dry is allowed to become wet and then changed instead of being taken to the toilet to help prevent them becoming wet. Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. Complaints are generally listened to and acted upon when communicated directly. Staff receive training in safeguarding adults but their knowledge of reporting systems potentially places residents at risk. Some residents have their movements restricted and it is not always clear how this decision has been made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager reports that three complaints have been received and that all have been substantiated and acted upon. The commission have not received any complaints. In surveys residents say that staff listen to them and act upon what they say. However, less able residents are not able to easily communicate their complaints. Staff do not show an understanding of how different behaviours which might equate to a complaint and this is not addressed in the planning of care. This is not always the case. During this inspection the inspector noted that residents ‘complained’ through their behaviour about staff indiscretion, being wet, being walked too quickly and having their handbag removed from over their shoulder. Care plans and discussions with staff show that these, and Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 19 other forms of communications, are viewed by staff as ‘misbehaviours’ and appropriate actions are not therefore always taken. The home routinely employs a keypad system aimed at keeping people safe. This limits some residents from going to their bedrooms and limits all residents from entering some areas of the home. None of the residents hold the number to this system and there is no documentation detailing how the decision for each individual resident to have their movements restricted has been arrived at. Staff receive training in safeguarding adults and this has and is being updated. They demonstrate a good knowledge of what abuse is but are not as familiar with how they might report this. This may result in actions to protect residents being delayed. Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. Quality in this outcome area is good. This is generally a safe home that is clean and hygienic. Some areas are very homely whilst others are more functional and access to the garden is limited. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys residents, or their supporters, say the home is clean and fresh. This was found to be the case during this inspection. Staff were observed following infection control guidance and washing their hands and using alcohol gels to prevent the spread of infection. Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 21 The home is split into two communal areas. One is very homely with many traditional and homely features such as a fireplace, pictures, paintings, flowers and plants. This part of the home includes the front door and entrance hall meaning that residents are involved in the coming and goings of the home. It was however noted that the lounge does not have a call bell that works. Residents report that they get help by calling out when they see a member of staff passing. The inspector heard one resident call out on three separate occasions when staff passed before they were heard. The other part of this home is more functional with little, apart from magazines and a TV, for residents to engage with. In addition there is little to help residents to understand their surroundings or find their way around, as the communal rooms are bland and furnished in a sparse fashion (although much of the furniture is good quality and new). There are grounds to the front and rear of the home. The front of the property is not secure and leads onto the road outside so is not safe for some residents to use without assistance. The rear is grassed and secure but is uneven and not well used. There are plans to improve this in the short term. It was noted that the fire door at the top of the stairs does not always close properly and this was reported to the manager. Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. Staffing numbers are adequate to meet the needs of residents. However, staff skills are not always meeting the needs of residents who have dementia. The recruitment procedures are placing residents at risk of potential harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota shows that there are usually eight members of care staff on duty in the morning, five in the afternoon and evening and two members of staff on duty at night. Care staff are supported by a manager, deputy manager, cook, kitchen assistant, cleaner and administrator and each shift has a designated leader. Staff and the manager report that the owner of this service is placing a strong emphasis on training. This is reflected in the recent Investors in People report which commends the owner for this commitment. The manager reports that induction training has been improved and that 50 of the staff are now trained to NVQ level 2 or above. Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 23 As this is a home for people with dementia all staff receive training in caring for people with dementia type illnesses. However, staff understanding of this disability is variable. Although kind and well meaning some staff told the inspector of, and were seen using, strategies for caring for people with dementia which are considered not good practice and which are out of date. Some staff, although they demonstrate a better understanding of dementia, were observed not putting this knowledge into practice. Three staff recruitment files were inspected. All had a completed application form and two of the three had two written references. One file only contained one written reference, although there was evidence that the manager had tried to get a second. However, all of these staff were employed and were working at the home prior to a police check being received. The manager says that she thought that police checks did not have to be carried out on people recruited from abroad until three months after they had been working. This is not the case. All of these staff have since received completed satisfactory police checks. Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Quality in this outcome area is adequate. This is generally a well managed home where residents’ health and safety are promoted and they are safeguarded from financial abuse, although there are some shortcomings. Some records are not being held confidentially meaning that some information which is private is being made public. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This home is managed by an experienced and suitably qualified manager who Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 25 is well supported and appreciated by the staff team. Staff say they see her as a good role model and have great regard and respect for her. The manager is aware of the need for her and her staff to keep up to date with best practice and has identified that she needs to update her own skills in relation to caring for people with dementia. The manager shows an understanding of the ethos and business plan of the new owner, and a strong support for this. Whilst she shares this vision and is working towards running the home in the best interests of residents, this is yet to be fully achieved. The monies of three residents were checked and these were found to be in order. Records are well kept and all accounts contain appropriate receipts and are auditable. The manager reports that mandatory training in fire safety and drills, food and hygiene, infection control and moving and handling are in place. However, one member of staff was wearing flip-flops placing herself, other staff and residents at risk of injury. Quality assurance processes that meaningfully involve all residents have yet to be developed and some confidential information is open to view by anyone who passes. The owner is not carrying out regular unannounced visits to the home to check on the quality of services provided. In addition, and as identified in other sections of this report, there are some management shortcomings in relation to record keeping, planning of care and recruitment practices. Thornfield Care Home DS0000068262.V317143.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 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 2 8 3 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 2 x 2 x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x 2 2 Thornfield Care Home DS0000068262.V317143.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. Standard OP7 Regulation 15 (1) Requirement Each person living at the care home must have a plan of care that identifies all their individual needs and which offers instructions for staff on how these needs should be met in a consistent way. You must ensure that each plan is reviewed so that changing needs are identified and appropriate actions to be taken are recorded and their effects reviewed. 2. OP9 13 (2) All medications prescribed by a doctor must be given as stated on the prescription and not altered in any way, unless the alteration has been made by a doctor. A record of all medications administered, including creams applied by staff, must be kept and signed for by the person administering the medication. Each resident must have their social needs and interests identified and you must make DS0000068262.V317143.R01.S.doc Timescale for action 30/06/07 30/04/07 3. OP9 13 (2) 30/04/07 3. OP12 16 (2) (m) (n) 31/07/07 Thornfield Care Home Version 5.2 Page 28 4. OP18 13 (6) 5. OP18 13 (7) (8) 6. OP19 23 (4) 7. OP22 23 (2) (c) 8. OP29 19 (1) (b) 9. OP31 26 (2) (3) (4) (5) 10. OP31 9 (b) (i) arrangements to enable these needs to be met. This is particularly important for those people with dementia. In order to safeguard residents staff knowledge regarding reporting mechanisms must be improved so that they would know how to use these if necessary. The use of the key pad system in the home is a form of restraint. As such it should only be used where other measures have failed and the circumstances that have led to its use must be recorded. The fire doors within the home, on this occasion the door at the top of the stairs, must close firmly in order to prevent the spread of fire. The call bell system in the lounge must work so that residents can summon assistance quickly and easily when needed. In order to protect residents each member of staff must undergo robust recruitment procedures before they can work at the home. This includes obtaining a new police check for every member of staff who comes to work at the home. The provider must visit the home at least once monthly on an unannounced basis. He must do this so that he can form an opinion as to the standard of care provided in the home. He must record his findings and send these to the commission after each visit. In order to provide effective leadership and quality services the manager must update her skills in relation to caring for DS0000068262.V317143.R01.S.doc 31/07/07 31/08/07 30/04/07 30/06/07 30/06/07 30/06/07 31/08/07 Thornfield Care Home Version 5.2 Page 29 11. OP33 24 people with dementia and person centred care. In order to ensure that the 31/07/07 service is run in the best interest of resident and takes accounts of their diverse and complex needs, effectively quality monitoring systems should be put in place. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. 1. OP7 Each residents care plan should include their previous and current interests and their social care needs so that these needs and preferences can be met in an individualised way. Each resident should be treated as an individual and staff should ensure that they are respecting each resident’s right to be treated with dignity at all times. Residents should be supported to exercise choice and control over their daily lives. This includes taking into account people’s preferences for going to bed and getting up times. All residents should be offered the opportunity to take their meals in pleasing surroundings in a social and enjoyable way. Those residents who need help should be offered this in an appropriate way, which maintains their abilities, and discreetly. Residents who have communication difficulties, such as dementia, and who cannot use the standard complaints procedure, should have opportunities to have their ‘complaints’ heard and interpreted through their behaviour. In order to support residents living at this home effectively all staff should have the skills necessary to care for people with dementia in a person centred way. Information about residents should not be written on the whiteboard in the dining area but should be kept confidentially. 2. 3. OP10 OP14 4. OP15 5. OP16 6. 7. OP30 OP37 Thornfield Care Home DS0000068262.V317143.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 © 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 DS0000068262.V317143.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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