Inspection on 03/10/07 for Thornfield Care Home [Seaton]

This inspection was carried out on 3rd October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Thornfield Care Home [Seaton] 28/01/09

Thornfield Care Home [Seaton] 04/03/08

Thornfield Care Home [Seaton] 03/04/07

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 Inspection 3rd October 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.V346342.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.V346342.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.V346342.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd April 2007 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 other parts 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 current fees range from £372.00 - £625.00 per week. Fees do not include items such as taxi fares and the cost of newspapers or toiletries. Those people who wish to use incontinence aids and are not assessed as needing them by the district nursing service pay for their own. Further information about this home is available direct from the home. Thornfield Care Home DS0000068262.V346342.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 7.00pm. During that time we spent time talking with residents, with care and ancillary staff, visitors 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 observing the care offered by staff. We chose to look at the care and accommodation offered to four people living at the home as a way of judging the services overall. We looked at how staff interacted with these people, we looked at their care plans and the inspector spoke with staff about how they meet the care and individual needs of these residents. We tried to look at the communal and bedroom space from their perspective. 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 20 people who live here and 11 were returned (some had been completed by relatives or friends on their behalf); to 15 members of staff and 3 were returned; to 12 relatives and 4 were returned; to a variety of health and social care professionals and 8 were returned. Their comments and feedback 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 general management information. What the service does well: Each person who thinks about coming to live at Thornfield has their needs assessed to make sure that Thornfield can meet those needs. They are invited to visit or, if they are unable, to have friends or relatives visit on their behalf. People say they have enough information on which to base their decision and that staff helped them to settle in. All say they have a contract which identifies the room they are contracting for and which are described as ‘plain and fair’. People’s general healthcare needs are well met through referrals to appropriate healthcare professionals, and from putting their advice into practice. Meals at the home are enjoyed by the people who live here. They like that they are home made and that it is ‘good English cooking’. Three people have made complaints to the home and these have been dealt with appropriately. There is an invitation for people to make complaints if they wish that is worded in a way that helps people to be comfortable about making complaints. Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 6 More than 50 of staff at this home hold a National Vocational Qualification (NVQ) in Care. Staff are described as ‘kind’, ‘lovely’, having exceptional patience and good humour. We observed that they work very hard and are caring. We also observed and got feedback saying that staff want to do the best for the people they care for. Monies managed on behalf of the people who live here are managed well and are kept safely and securely. What has improved since the last inspection? What they could do better: During this inspection we found a number of areas of risk that could adversely affect the people who live here. These include people not being safeguarded from harm and a fire door not closing shut and fire checks lacking detail. This is the second successive inspection where we have found failings in relation to fire prevention. We have written to the owner requiring him to address these issues immediately. He has responded saying that appropriate actions have been taken. We also found that sufficient actions had not been taken to address the shortcomings identified and requirements made at the last inspection. People living here are not having their care planned in a way that meets their mental health needs and which is person centred. Care planning and decisions made on behalf of people living here are not carried out within a risk management framework and/or are not well documented. Staff are not making decisions using the Mental Capacity Act (2005) and the principles underpinning this Act. We found that it is not clear if all the people living here are getting all the medicines that the doctor is prescribing. We checked three people’s medicines and found in all three that people had more tablets than they should have according to their records. We found that staff are sometimes crushing one person’s tablets and putting them in their tea. The multi-disciplinary team has not agreed this and it is not clear that this is in the best interests of this person. In addition, drugs prescribed to be given when needed are being given regularly. Staff do not have instructions about what the necessary conditions are to give these drugs and do not record why they gave them and the affect that they have. It is unclear if people are having their prescribed creams applied because staff are not signing to say they have done this. Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 7 People living here who have dementia are not always treated with respect and dignity, do not always have their complaints heard or their social needs met and are not always given choices in their daily lives. Some peoples’ freedom of movement and liberty continues to be restricted and these decisions are not being made using a risk assessment framework or in line with good practice. People who sit in one of the lounges cannot summon help because the call bell in this room does not work. Staff, whilst well meaning, kind and hard working, have not all received appropriate training and not all have the necessary skills to care for people with dementia. Care plans do not give them directions on how to care for each person living here in a person centred way. In particular staff have not been supported to develop the skills to care for people who challenge the service. Staff recruited since the last inspection have not undergone rigorous checks before they work with people and this is putting people at risk of harm. Some staff might benefit from having English language lessons because some people could not easily understand them. New staff do not have induction training that meets their needs. Staff would also benefit from further training in moving and handling people and how to prevent pressure sores. In addition, the home does not have sufficient moving and handling equipment to meet people’s needs. Staff are not following infection control guidance putting people at risk of infection. The management systems in place in this home are not bringing about the quality of services and the improvements required to meet National Minimum Standards. Job descriptions do not describe roles adequately. The person who is carrying out monthly unannounced visits is not forming an opinion as to the standard of care provided and appropriate actions are not being taken. The manager has attended a conference about caring for people with dementia but has not any additional training to meet her identified learning needs. The time that supper is served is early and may therefore not be meeting people’s nutritional needs. In addition, people are not being helped to maintain their skills, abilities and independence because staff are carrying out tasks (such as feeding people) which they can do this for themselves. Whilst some improvements have been made to the environment of the home, one lounge remains less than homely and some of the wall decorations and flooring could confuse people with dementia. Visitors are made welcome, some people would like the opportunity to visit with their relative or friend in private and this is not offered. Bedrooms are not all personalised and do not all have signage that helps the person that the room belongs to, to recognise the room as their own. Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 8 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.V346342.R01.S.doc Version 5.2 Page 9 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.V346342.R01.S.doc Version 5.2 Page 10 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): 2 and 3. Quality in this outcome area is good. People who think about coming to 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: 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 obtains a copy of any assessment and care planning information available from them to ensure the home has comprehensive information about each person. This information is used as the basis of care planning. Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 11 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 comments that contracts are ‘plain and fair’. Another person comments that they visited the home on a number of occasions to see if it were the right place for their relative. Another person said that staff had helped their relative to settle in. Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 12 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, 8, 9 and 10. Quality in this outcome area is poor. People living here have their general healthcare needs met. This could be further improved if risk assessments and appropriate actions were taken in relation to the prevention of healthcare problems such as pressure sores. There have been no improvements in care planning since the last inspection. Some people are being put at risk because their psychological healthcare needs are not being adequately addressed. Medication is managed poorly and some practices in relation to the management and administration of medicines are placing people at potential risk. Care staff do not have the skills to ensure that people are treated with respect and with dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 13 In surveys, 50 of people say they always get the care and support they need and 50 say they usually or sometimes do. Healthcare professionals who visit the home are largely satisfied with the standard of healthcare provided. One healthcare professional comments that the home ‘ask for, listen to and act on advice’. However, another comments that people ‘frequently have small traumas to limbs’ and that ‘staff need more training and support’. When we looked at the care of the four people we case tracked we found that their healthcare needs are generally met. These people are registered with a doctor and see the chiropodist and optician when needed. Referrals are made to the district nurse and to the community psychiatric nurse. One person living at the home currently has a pressure sore which staff report is almost healed. However, some healthcare staff are concerned that some people might develop pressures sores when they could have been prevented. We looked at these peoples care plans and found that the assessments used to determine if people might be susceptible to pressure sores do not use a format that brings about consistency or objectivity. Staff have not received training in how to carry out such risk assessments, and care plans do not give instructions to staff on how to prevent pressure sores from happening. We also noted that one person had multiple bruises on their arms and hands. Staff say that this is because their skin is very fragile. The care plan does not provide staff with instructions on how to prevent or limit damage. We observed staff lifting this person using an inappropriate technique, which could potentially cause damage to the person’s skin and during which the person cried out in pain and asked the staff to stop. Some staff say that they have had moving and handling training but that this was not related to the delivery of care and none that we talked with had been taught ‘gentle handling’ which helps to prevent skin damage or tears. Staff say they would like more equipment to help with moving the people who live here. They pointed out some people who would benefit from additional equipment. A letter sent to the commission from the management team indicates that someone was lifted from the floor using a towel, which is potentially harmful to both the person being lifted and the staff who are lifting. The home currently has one hoist and no stand aids. The manager reports that another hoist is being purchased and should arrive shortly, and that they plan to get a stand aid. The information sent to the commission by the manager prior to the site visit identifies that the majority of the people living at Thornfield have dementia type illnesses. We found that some people admitted recently have complex needs and that some have behaviours that are challenging the service. Whilst referrals have been made to nurses and to doctors care plans do not all provide staff with instructions on how to prevent or manage such behaviours. Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 14 When we spoke with staff they say that these issues are not discussed with them and they have not been helped to develop the skills needed to care for these people. We observed well-intentioned and caring staff interacting with some people who live here in a way that caused or contributed to aggressive outbursts. We saw one person get so upset that they put themselves on the floor and banged their head against the wall causing injury to themselves. Feedback from some healthcare professionals is that people are not always treated with respect. We saw evidence of this. For example, staff were heard to interrupt people when they were speaking, we saw staff ignoring people when they were talking and we observed staff changing the subject when they could not understand or deal with what the person wanted to express. We saw staff allowing people to shout at and be rude to other people. We overheard staff calling people ‘feeds’ and ‘the dementias’. We looked at how peoples’ medication is managed, particularly in relation to the people we case tracked. Records show that staff are asking the doctor to increase the medication of some people who are challenging the service. We talked to staff about how they manage such behaviours and they say they have not been given instructions or advice and have not tried other ways to manage these behaviours. We found that some staff are crushing the medication of one person and putting it into their drink. There is a letter, apparently from a doctor, saying this is allowed but staff are not sure who has signed this letter. It is best practice to ensure that this only happens after all other avenues have been explored and only if it is in the best interests of that person. Records do not show that this has taken place. We found that the medication administration record shows that this person should be having this medication when it is needed. However, staff say they are giving it on a regular basis. We also found that staff had different ideas about the circumstances that would lead to it being given and that the care plan did not provide instructions for staff about when to give it or what to try instead of medication. We found that medications are stored safely in locked cupboards and that records appeared in order. However, when we counted some people’s medicines we found that they had more tablets than they should have. We counted three different peoples and none of them tallied with the records. We also found that staff are not signing to say they have applied prescribed creams although we asked that this be dealt with at the last inspection. Thornfield Care Home DS0000068262.V346342.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, although they cannot always do this in private. Further improvements have been made in the provision of social care. However, people cannot yet be assured that their interests will be taken into account and used to help them to engage with the world. People with dementia are not helped to exercise choice or control in their daily lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys there was a mixed response relating to whether the home are providing activities that people can join in with. 33 said that the home always provide such activities, another 33 said they usually do and the remainder say they sometimes or never do. Healthcare professionals comment Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 16 that this is an area that could be improved, particularly for those people with dementia. When we looked at the programme of activities a ‘music man’ comes on Monday, and some people are taken for a walk. On Tuesday there is bingo or games and the hairdresser visits. On Wednesday a DVD is played. On Thursday people are offered manicures. On Friday there is a reminiscence session. On Saturday there is a quiz and Sunday is ‘family day’, when the manager reports the home has a lot of visitors. In addition to this the home now has the use of a minibus on Mondays and Wednesdays when trips out are undertaken. People spoken with say how much they enjoy these. Care plans show how well people respond to these and how it lifts their spirits. We also saw a member of staff throwing a large air filled ball with some people who have dementia. They were laughing and smiling. Staff told us that a person is assigned every day to this area to help with activities. However, they have had no training in this area of care. One relative comments that they think the home needs more activities to stimulate people, especially those people with dementia. Some of the activities offered may not do this. In the care plans we saw that information has been collected about each persons past life, their social interests and the activities they have taken part in before coming to live at Thornfield. However, we observed that this information is not always used in a positive way to help that person engage with the world. For example, when one person was becoming frustrated a member of staff reminded the person what car they used to drive and what their occupation was as a way of distracting them. In addition, the inspector was told that one person living at the care home used to grow their own vegetables. When asked how staff use this information to help to improve this persons quality of life, staff did not know. Another person likes to sing but staff asked this person to do this at a time when they were happily playing cards. Care plans show what religion each person living here is. However, this information does not extend to how they practice this religion and therefore how they might be supported to continue with this. Visitors to the home say that staff are friendly and helpful. Some say they would like to be able to visit with their relative or friend in private and that this is not offered. One person said that they are often invited to take a meal with the person they visit and how much they appreciate this. In surveys 50 of people say they always enjoy the meals and 50 say they usually enjoy the meals. On the day we visited there was roast turkey, roast potatoes and vegetables for lunch followed by rice pudding. People say they look forward to breakfast and lunch, but had little to say about supper. When we checked, we found that supper is served between 4.30pm and 5.00pm. The manager reports that people can have soup and sandwiches or, for example, Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 17 something on toast or a fried meal. However, as lunch does not tend to finish until 1.30pm, people may not be hungry enough to have supper at this time. People say they sometimes ask for, and always get, something to eat later. However, those people with dementia cannot ask for this. People who need help with their meals are given this. However, we also saw that when giving assistance some staff stood over the person instead of sitting with them. We also observed that some people were given assistance when they did not need it. One person stopped feeding themselves and another got annoyed and would not eat their dinner. Staff continued to try for over 30 minutes, even though it was clear this person did not want it. When given their sweet, this person ate without help. However, when a member of staff tried to take the spoon and feed this person, they stopped eating. In total this person ate half a bowl of rice pudding. When they tried to reach for the jug of juice this was taken away from them. These observations are in line with comments received from health and social care professionals who comment that those people who cannot easily communicate their choices are not always given choices. In addition we were told that one gentleman’s beard and moustache were cut off without consultation or permission. Thornfield Care Home DS0000068262.V346342.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 poor. When people can directly communicate their complaints, these are acted upon. However, the complaints of people with dementia are not always understood and therefore are not always acted upon. People are not kept safe from harm from other people they live with. Although there have been some improvements, people’s movements continue to be restricted without clear decision making processes and outside the principles of good practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Thornfield has a complaints policy that is worded in a way that helps people to feel comfortable about making complaints. When spoken with people say they have no complaints and any niggles are dealt with quickly and easily. In surveys the majority of people say they know who to speak to if they are not happy. People clearly recognise the manager and make their thoughts and wishes known to her, and appropriate actions are taken. However, we observed some people with dementia ‘complaining’ and being ignored. For example people indicated they did not want help with eating, they were short with staff when they had waiting a long time at the dinner table to Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 19 be served and they shouted at being moved. Staff did not interpret these as complaints. They say this is ‘what people with dementia do’. The home has received three complaints, all of which have been dealt with. Incidents that have occurred at the home have led staff and the psychiatric nurse. However, they have not protection team as they should have using the agreed Guidance). This is putting some people are at risk of agreed to do this as a matter of urgency. to contact the doctor contacted the adult procedures (Alerter’s harm. The manager During the inspection we observed people living here shouting at each other, one person stood over another in an intimidating way and a member of staff had a drink thrown at them. All these incidents happened in front of senior staff who took no action. At the last inspection we required the home to ensure that when people’s movements and liberty were restricted that it was clearly recorded how this decision had been made and who was involved in the decision. Some people are not allowed access to the entire home as there is a keypad system in use. Some people are cared for in reclining chairs using a lap belt. People’s care plans contain forms relating to some of these restraint issues. However, none seen are based on a risk assessment or involve other professionals in the decision making process. Some have not been signed or dated. Thornfield Care Home DS0000068262.V346342.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, 24 and 26. Quality in this outcome area is adequate. Improvements to the home are ongoing, however the people who live here are not always kept safe from the risk of fire or from the spread of infection. Some improvements to the home are being made which are not always taking into account what is best practice in relation to environments for people with dementia. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys people say that the home is always or usually fresh and clean. However, when we checked the toilets and the laundry we found that infection control practices are placing people at risk. Whilst toilets have hand washing and drying facilities the bin in one toilet cannot be easily reached. We found 5 Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 21 used hand towels behind the taps and pipes. Staff were aware that this happens but had not taken actions to deal with this. The manager reports that they have increased the number of commodes in the home so that people can use the toilet more easily and in their own rooms as some of the toilets are quite small. In the laundry we found soiled and clean clothes lying next to each other, meaning that cross infection might take place. We could not easily reach the hand washbasin because the area below it was cluttered with mops and buckets, which might mean that some people cannot wash their hands easily. When we talked to staff they say that laundry is not the responsibility of one person. Carers on duty also do laundry work. We talked to people who live here who say that despite their clothes being marked with their name, that they do not always get their own clothes back and sometimes get clothes that do not belong to them. We found that the laundry door, which is a fire door, is not always closing properly. On 4 out of the 5 times that we visited this room the fire door was not completely closed. We required the manager to address this immediately. In addition the fire checks lack detail. For example, it had been recorded that some fire doors needed attention from the maintenance man, as they were not closing properly when the fire alarm sounded. Which doors needed attention had not been recorded. The maintenance man is not employed by the home, but comes at his own discretion. The manager reports that the home is due to have a risk assessment in relation to fire in the near future. The kitchen was found to be clean and tidy. Foods kept in the fridge and freezer are covered and their date of opening recorded. Fridge and freezer temperatures are recorded. The environmental health officer visited in January this year and did not make any recommendations to improve practice. At the last inspection we asked that a working call bell be placed in the lounge so that people could call for assistance when needed. This has not been done. Some staff thought it might be a good idea of people had pendant alarms that hang around their neck, so that wherever they are they can call for assistance when needed. One person thinks that each bedroom should have a waste paper basket and we have passed this information onto the manager. One lounge remains very homely and, whilst some pictures have been put up, the other remains functional. Since the last inspection the hall floor has been changed. The tiles are black and white diamond shaped and can produce an Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 22 optical illusion that the floor is moving or is uneven. This is not a good type of pattern for people with dementia. In addition, we also discussed with the manager that the multi faceted mirrored wall hanging and the mirror that produces a distorted image might be confusing to some people. We went into some bedrooms. Some are personalised and homely. Others are not. We visited one bedroom that has vinyl flooring and is very sparsely furnished. There are no pictures, personal possessions or mementos belonging to this person in the room. The walls were marked with splash stains and hand marks. The door did not have the persons name or any signage that would help them to know their own room. Staff were heard repeatedly telling this person the number of their room which this person finds difficult to remember. Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 23 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 do not have the skills needed to meet the needs of people who have dementia. The recruitment procedures continue to place people 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 report that part of their daily duty is also to clean the bedrooms of the people they help to get up and that carers are responsible for laundry work. Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 24 The majority of people say that staff are usually available when needed and others say they are always available. We observed that staff work very hard, are very busy and try really hard to meet people’s needs. Comments from relatives about the staff include ‘they are friendly and caring’, ‘staff create a good general atmosphere’ and ‘they deal with vulnerable and challenging people with patience and humour’. One person commented ‘I visit everyday and find (my relative) groomed, clean, healthy, and most importantly, happy’. We looked at induction training records and found that this is not based on ‘Skills for Care’ common induction standards as it should be. The manager reports that over 50 of staff hold a National Vocational Qualification (NVQ) in care. One carer, in a survey, commented that their induction had not prepared them to care for people living at the home. Two carers said they would like to do their NVQ training. In surveys staff say that they are sometimes given up to date information about the needs of the people they are caring for, that they have not all had training relevant to their role, that they do not always understand the needs of all the people who live at the home and that they are not kept up to date with new ways of working. Healthcare professionals say that ‘staff seem stressed’, that ‘not all staff are skilled in communicating with people with dementia’ and ‘I wonder is the staff/resident ration sufficient’. Two healthcare professionals comment that they thought some staff needed support to improve their English. We discussed this with the manager who does not think this is a problem. We spoke with some staff who come from abroad. They did not all easily understand what was being said. Whilst there is no suggestion that there is any malice or intent, we did observe that not all staff have the skills required to care for people with dementia. We looked at the recruitment file of the one person that the manager reports has been recruited since the last inspection. This showed that at the time of employment, all the checks required to help keep people safe had not been carried out. In this case, a police check was carried out a month after this person started work and a check relating to the protection of vulnerable adults (POVA check) two weeks after starting work. This places people at potential risk of being cared for by people who are not suitable. Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 25 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 and 38. Quality in this outcome area is poor. The overall management of this home has deteriorated. Some people are at risk of harm and their welfare is not being promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection we required this home to make improvements relating to both reducing risk and improving the quality of care and services provided. We required improvements in the planning and delivery of care, both psychological and social, and that the manager update her skills; we required the management of medication and fire prevention be improved; we required that staff be made familiar with how to report an allegation or concern relating to Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 26 safeguarding adults, and that robust recruitment checks take place; we required that people have access to a call bell to summon assistance when needed; we required that the owner arrange to carry out unannounced visits to the home so that they could form an opinion as to the standard of care provided in the home. These improvements were to be achieved by August 2007. Whilst some improvements are in the pipeline or have started to be implemented, the management team have not been successful in fully meeting any of these requirements. The manager reports that her job description has not been reviewed since she has taken on extra responsibilities and duties. New roles have been introduced and job descriptions for these posts have not been established. The manager reports that she started to organise training for herself and staff in caring for people with dementia. However, she does not have a budget to commission this. Minutes of a staff meeting show that the manager had requested a dedicated laundry worker and this is yet to happen. In addition the manager has not received training in relation to the extra administration work she is undertaking. Quality monitoring systems have commenced and a survey carried out. We were shown that surveys were sent to six visitors to the home. Four of these commented that they could not see the person they were visiting in private and two that staff didn’t explain procedures. Some people gave ideas for alternative activities. These included snooker, knitting and card games. No action has been taken in response to this feedback. Whilst a new training supplier has been identified, training with this company is yet to commence. As noted in the ‘Staffing’, induction training is not based on the common standards and is not meeting the needs of some carers. We saw records showing that electrical testing is taking place and that some fire checks, including a weekly fire alarm test, is happening. However, as noted in ‘Environment’ fire safety procedures are not adequate. The manager reports that all catering staff have received training in food hygiene and that other mandatory training continues. We checked the monies of three people held and managed on their behalf. These are kept safely and securely and access is limited to key people and keys are kept safely. All three accounts that we looked at were in order. Receipts are kept for all purchases and balances tallied with records. Decisions made on behalf of the people who live here are not being made within a risk assessment and action framework. This includes issues relating to choice, moving and handling, freedom of liberty and restraint. Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 27 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 2 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 1 x x 2 x 2 x 2 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 x 1 1 Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 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. The care plan should include how to meet the needs of people with dementia and should be person centred. 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. Previous timescale of 30/06/07 not met. 2. OP8 12 (1) People living at the home must have their health and welfare needs met. This includes meeting the mental health needs of those people with dementia. All medications prescribed by a doctor must be given as DS0000068262.V346342.R01.S.doc Timescale for action 31/01/08 31/01/08 3. OP9 13 (2) 31/10/07 Page 29 Thornfield Care Home Version 5.2 prescribed by that doctor. This includes giving medications that are prescribed on a ‘when needed’ basis, and not on a regular basis. This will ensure that people are only given the medicine they need. Previous timescale of 30/04/07 not met. 4. OP9 13 (2) Medicines must not be given to people covertly unless this has been specifically stated by the doctor on the prescription relating to that medicine. When staff administer medicine covertly the reasons for this should be clearly recorded; agreed by the multidisciplinary team and be in the persons best interest. In such cases decisions must be made within the Mental Capacity Act (2005), using the key principles of that act. 5. OP9 13 (2) When people are prescribed medications to be given ‘when needed’, the care plan should include the conditions or circumstances under which these should be given. A record should also be kept of the reason for giving the medicine and the effect the medicine has. This will ensure that people only receive the medicines they need and that their effects can be taken into account when planning their care. A record of all medications administered, including creams applied by staff, must be kept. The person administering the medication must sign this for. This will ensure that people get DS0000068262.V346342.R01.S.doc 31/10/07 31/10/07 6. OP9 13 (2) 31/10/07 Thornfield Care Home Version 5.2 Page 30 all the medications they are prescribed. Previous timescale of 30/04/07 not met. All the people living in the care home must be treated with respect and with regard to their dignity at all times. Each person living here must have their social needs and interests identified and you must make arrangements to enable these needs to be met. This is particularly important for those people with dementia. This should include helping people to exercise choice in relation to religious practice. Previous timescale of 31/07/07 partially met. 9. OP14 12 (2) Each person living at the home must be supported and enabled to make decisions so that they have as much control over their lives as is possible. In order to safeguard the people who live here against potential abuse staff knowledge regarding reporting mechanisms must be improved so that they would know how to use these if necessary. Previous timescale of 31/07/07 not met. 11. OP18 13 (6) In order to safeguard the people who live here a referral must be made to the Adult Protection team so that a decision can be made by the multidisciplinary team as to how one person’s behaviour should be managed to DS0000068262.V346342.R01.S.doc 7. OP10 12 (4) 31/01/08 8. OP12 16 (2) (m) (n) 31/01/08 31/01/08 10. OP18 13 (6) 31/01/08 05/10/07 Thornfield Care Home Version 5.2 Page 31 prevent harm to others. A requirement was issued at the time of the inspection stating that this must be actioned immediately. The use of the key pad system in 31/01/08 the home is a form of restraint. As such it must only be used where other measures have failed and the circumstances that have led to its use must be recorded. Decisions about restraint must be made using the key principles of the Mental Capacity Act (2005). Previous timescale of 31/08/07 not met. 13. OP19 23 (4) The fire doors within the home, on this occasion the door to the laundry, must close firmly in order to prevent the spread of fire. A requirement was made at the last inspection in relation to the door at the top of the stairs. Therefore previous timescale of 30/04/07 is partially met. A requirement was issued at the time of this inspection stating that this must be actioned immediately. 14. OP22 23 (2) (c) The call bell system in the lounge must work so that people can summon assistance quickly and easily when needed. Previous timescale of 30/06/07 not met. The home should have enough aids, hoists and other equipment DS0000068262.V346342.R01.S.doc 12. OP18 13 (7) (8) 05/10/07 31/10/07 15. OP22 23 (2) (c) 31/12/07 Thornfield Care Home Version 5.2 Page 32 to meet the needs of the people who live here. 16. OP26 13 (3) In order to protect people from infection, the management of soiled and clean laundry is must be reviewed and action taken to separate them. In addition people must be able to easily dispose of used paper towels to promote hand washing and prevent the spread of infection. 31/12/07 17. OP29 19 (1) (b) In order to protect the people 31/10/07 who live here from staff who are unsuitable to work with vulnerable people each member of staff must undergo robust recruitment checks before they can work at the home. This includes obtaining a police check or POVA check for every member of staff who comes to work at the home. Previous timescale of 30/06/07 not met. 18. OP30 18 (1) (a) (c) 30/06/08 In order that the needs of the people who live here can be met, staff must be suitably trained and be competent. Carers must receive training that is appropriate to the work they do and this must include caring for people with dementia and training relating to the Mental Capacity Act (2005). The provider must visit the home 30/11/07 at least once monthly on an unannounced basis. He, or a representative, must do this so that they can form an opinion as to the standard of care provided in the home and take any actions needed to address shortcomings. DS0000068262.V346342.R01.S.doc Version 5.2 Page 33 19. OP31 26 (2) (3) (4) (5) Thornfield Care Home They must record their findings and send these to the commission after each visit. Previous timescale of 30/06/07 partially met. 20. OP31 9 (2) (b) (i) In order to provide effective 30/06/08 leadership and quality services the manager must update her skills in relation to caring for people with dementia and person centred care. Previous timescale of 31/08/07 not met. 21. OP33 24 In order to ensure that the service is run in the best interest of the people who live here and takes accounts of their diverse and complex needs, effective quality monitoring systems should be put in place. These must include taking actions after surveys have been carried out and feedback has been received. Previous timescale of 31/07/07 partially met. 22. OP37 17 Schedule 3 In order that decisions made on behalf of the people who live here are understood a record must be kept of any physical restraint used, which includes the use of recliner chairs and lap belts. Records relating to decision making processes that result in people having decisions made on their behalf, having their freedom of choice or liberty of movement restricted must also be kept. Decisions must be made using the key principles of the Mental Capacity Act (2005). 31/12/07 31/01/08 Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 34 23. OP37 17 24. OP38 13 All records kept relating to the people who live here must be accurate and up to date. This includes care plans, medication records and restriction of liberty and movement records. People living here must be assured that safe working practices are operating. This includes ensuring that staff are using appropriate moving and handling techniques; that staff all understand and implement appropriate fire procedures; that staff carry out appropriate infection control practices. 31/12/07 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations Staff should receive training in how to carry out assessments in relation to identifying those people who might be at risk of developing pressures sores and on decided what actions should be taken to prevent pressures sores developing. This will help to prevent people from developing pressure sores. 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. Meals should be served at times that suit the people who live here. 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. Each person living here should have a bedroom that is personalised and which has a carpet provided. DS0000068262.V346342.R01.S.doc Version 5.2 Page 35 2. OP15 3. OP16 4. OP24 Thornfield Care Home 5. OP30 In order to support people living at this home effectively all staff should have the skills necessary to care for people. Some staff might benefit from having English Language and culture lessons to improve their communication skills. Thornfield Care Home DS0000068262.V346342.R01.S.doc Version 5.2 Page 36 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.V346342.R01.S.doc Version 5.2 Page 37 - 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. 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