Inspection on 04/03/08 for Thornfield Care Home [Seaton]

This inspection was carried out on 4th March 2008.

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

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] 03/10/07

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 10:00 4 and 5 March 2008 th th 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.V359755.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.V359755.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 thornfieldcare@yahoo.co.uk 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 ****Post Vacant**** 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.V359755.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd October 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 and part of a conservatory. The other area has two linked sitting areas and a dining room. On occasion 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.V359755.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place as part of the normal programme of inspection. The site visit was undertaken by one inspector over two days, involving one whole day and an afternoon. During that time we (the commission) spent time talking with people who live here, with care and ancillary staff, visitors and the manager. As some of the people living at this home have dementia type illnesses and cannot communicate directly, some time was spent observing the care offered by staff. We looked 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 interact with these people, we looked at their care plans and we spoke with staff about how they meet the care and individual needs of these people. We looked at the communal and bedroom space from the perspective of people who live here. 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. In addition to this visit, we (an inspector and pharmacist inspector) carried out a shorter unannounced visit in January of this year to monitor the progress made following requirements made at the key inspection in October. We found that good progress was being made and that the quality of life for people living here had improved. Prior to this site visit surveys, asking for comments and feedback, were sent to all the people who live here and 3 were returned; to 11 relatives and 3 were returned; to 10 members of staff and 3 was returned; to 5 health and social care professionals and 2 were returned. We also spoke in person to health care professionals about the care provided in this home. Comments and feedback are included in the main body of this report. What the service does well: People who come to live here undergo an assessment that ensures their needs can be met. Their general and mental health needs are being met through the provision of appropriate care and referrals to healthcare professionals. No one living here has a pressure sore and people experience few falls. Their medication is managed safely and people receive appropriate medicines. Staff are developing the skills needed to care for the people who live here, who have specialised needs. They work hard and are committed to bringing about the improvements needed and to providing good quality care. They are Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 6 receiving training and supervision which is helping them to develop these skills. Some staff are exceptionally skilled and examples of this were observed during this inspection. The home has a calm atmosphere which helps people living here to remain relaxed and at ease in their surroundings. The home is clean and comfortable. People who are able to take part enjoy the activities offered which have included trips out, bingo and exercising to music. People are listened to and their needs are central to the organisation and running of this home. What has improved since the last inspection? Since the last inspection the general outcomes for people living here have improved significantly. The organisation and manager have worked hard to address the shortcomings identified and to ensure that people who live here have positive experiences. The provider, management team and staff are commended for this. The manager is currently applying to become registered with the commission. She is undertaking her Registered Manager’s Award and has registered to start a comprehensive training programme in caring for people with dementia. The manager is well supported by her staff and the management team. One person carries out monthly unannounced visits to the home as a way of ensuring the quality of care given to people is good. All care plans have been reviewed with a healthcare professional. Staff have received training in care planning and in meeting the needs of people with dementia. They have also received additional training in moving and handling people and additional equipment has been purchased to help staff to do this. Changes have been made in the staff structure to make the best use of staff skills. The number of staff providing care has been increased by allocating the responsibility for cleaning and laundry to housekeeping staff. Any newly recruited staff have been recruited using robust checks to help ensure that only appropriate staff work with this vulnerable group of people. In addition, changes to staff routine have bought about a much calmer environment that the people who live here are responded to. The management of medication has been completely reviewed and is now safe. This has included each persons General Practitioner reviewing their patient’s medications which has resulted in some peoples medicines being reduced. Actions have been taken to improve infection control and the prevention and management of fire. A maintenance man has been employed so that any maintenance issues can be dealt with quickly and easily. The use of keypads to Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 7 limit people’s movement around the home is now much reduced and is generally not used. Mealtimes have improved so that people can enjoy this time. People are receiving the help they need with eating and staff are doing this discreetly and in a way that helps to promote independence. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Thornfield Care Home DS0000068262.V359755.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.V359755.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): 3. Quality in this outcome area is good. People who think about coming to live in this home have their needs assessed to ensure that the home can meet these needs. More detailed assessment information would help those people who come to live here temporarily to maintain their routine, skills and abilities. This home does not provide intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager says that everyone who wants to come and live here is assessed. This assessment is used to determine people’s needs and to ensure that these needs can be met by the staff working in this home. Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 11 We looked at two assessments of people who had been admitted recently. We noted that these people have needs that are less complex than some people who have been admitted in the past. This means that staff can spend more time meeting everyone’s needs and less time concentrating on those who challenge the service. We found that the assessment records basic needs. Some information about peoples’ routines and preferences is gathered, but the majority of this is gathered over the weeks after admission. Whilst this may be suitable for people who plan to live here permanently, it is not suitable for people who come to stay here on a temporary basis (for respite) and are therefore only here for a few weeks. People who were able to comment say they enjoy living here and that the home is able to meet their needs. Thornfield Care Home DS0000068262.V359755.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 adequate. Improvements in this area of care mean that people living here have their general health and basic mental health care needs met. Ongoing improvements being made to the planning of people’s care is helping to achieve this. The management of people’s medicines has improved and is now safe. There are some outstanding issues which are being addressed. Although there have been many improvements in relation to ensuring that people are treated with respect and dignity, work is continuing to ensure that all staff understand and develop these skills. This judgement has been made using available evidence including a visit to this service. Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 13 EVIDENCE: Since the last inspection the majority of care plans have been reviewed by a senior member of staff. We looked closely at four of these and at the care these people receive. We found that each person has a comprehensive plan of care that is written in a way that helps staff to meet each persons needs in a way that suits that individual. Risks to people’s health, welfare and safety are identified and appropriate actions are taken. This has helped to ensure that no one living here has a pressure sore and that the number of falls experienced by people is minimal. The majority of falls relate to people who have a need to walk around the home which staff encourage and assist them to do. Staff have received additional training in helping people to move safely and additional moving and handling equipment has been purchased. We saw, in care plans, that appropriate moving and handling assessments have been undertaken and saw staff using appropriate moving and handling techniques. The manager has arranged for health care professionals to help with reviews of peoples needs and care plans. In addition staff have received training in how to meet the needs of people whose behaviour has challenged this service or who have dementia. Some people have been helped to find more suitable accommodation and care as this service could not meet their needs. Care plans include instructions for staff on how to improve or maintain peoples continence. However, we found that staff are not always using this very detailed information and that written reviews do not always use this information as part of the evaluation process. One relative commented that they were not sure that their relatives incontinence is due to her condition or to rigid toileting regimes. We saw that care plans give information about some people who get out of bed at night and why they might do this. Entries in the care plans show that staff are not using this information in a meaningful way. Staff are repeatedly putting one person back to bed without finding out how what they might do for this person to help them. The care plans we looked at include as one of the aims of care the maintenance of people’s abilities and independence. However, these care plans do not identify each person’s abilities and we saw some staff doing things for people that with the right support, they could do for themselves. Whilst this is done in a very caring way, it means that some people may lose the abilities they have and will therefore be less independent. Some entries in care plans show that staff are not following some of the instructions in them and are not reviewing care plans in a way that determines Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 14 if the care given is appropriate. Some entries made by staff indicate that a change to some care might be appropriate, but this has not been done. We talked to the manager about this. She is aware that not all staff understand how to achieve care planning successfully. Although staff have received some training, she recognises that they need more help and has made changes to the staff structure to enable this to take place. In addition the manager is due to attend training in caring for people with dementia that will include care planning. Professionals visiting the home say that the care of peoples physical and mental health care has improved and that staff and people living here are calmer and much more relaxed. We too observed this calmness and relaxed atmosphere that is contributing to preventing people from having behaviour that challenges the service. Relatives say they have in the past has cause to point out where improvements to care were needed, but have not had cause to do this recently. We looked at how medicines are managed. We found that the overall management of medicines has improved. All medications, including controlled drugs, are kept safely and securely. We found that the manager has arranged for each person who is taking medications to have their medications and health needs reviewed by their General Practitioner. This has resulted in some people having the amount and/or type of medicines reduced. We discussed procedures with the manager and care staff and looked at records. We concluded from this that medicines are being administered as they should be and in line with guidance from the Royal Pharmaceutical Society. We did find that some records were not up to date. For example, we found that two people had more medicines than records show they should have. This is because staff are not keeping a record of all medicines received into the home. This leaves these medicines open to abuse without anyone noticing. We looked at how staff help to ensure that people’s privacy and dignity is maintained and promoted. We found that some visitors had complained to the manager that sometimes the person they were visiting was wearing a piece of clothing that belonged to someone else. She is trying to address this. We noted that one persons trouser hem had come down. This not only put this person at risk of tripping but was not in keeping with their preference for a neat and tidy appearance. This person pointed this out to a number of staff over 2 – 3 hours until he was assisted to change. We saw that the majority of staff knock on bedroom doors before entering. However, some staff did not wait to be invited into the room but opened the door as they were knocking. We saw a photograph of one person that is used for identification purposes, which could be considered undignified. We saw some staff walking with people in a way that was too quick for them and we Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 15 saw some people being ignored or rushed past without acknowledgement. We also saw that staff ensure that any personal care required is given in private. We also saw some staff speaking and interacting with people very respectfully. They made sure that they spoke slowly and that the person could see them. They took the time to understand people and to assist them at a pace that suited them. We observed on incident where a carer quickly recognised that a person was becoming agitated. They skilfully and discreetly gained this persons attention. They carried out an interaction that averted a potential aggressive outburst and at the same time clearly made this person feel special and respected. Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 16 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. Further improvements have been made in the provision of social care. However, this area of care is yet to be fully developed so that all the people who live here are enabled to engage with the world in a way that promotes their quality of life. 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. Although there have been some improvements, people with dementia are not always helped to exercise choice or control in their daily lives. People have a nutritious diet taken in relaxed surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 17 Since the last inspection this home has employed a full time activities coordinator, revised the activities offered and introduced trips out. However, the activities co-ordinator has been on sick leave and although the manager has tried to have this role filled, activities and ways of engaging people living here have not been as successful as planned. People say how much they enjoy the trips out on the minibus and some people say they enjoy bingo and just chatting. The TV in one lounge has been moved so that it is easier for people to watch. Care plans show that interests and abilities, plan stated that one based on information some months later. there are plans to help engage people based on their but that this is work in progress. For example one care person was to have a programme of activity devised and help from their relative. This has yet to be done Another care plan noted the persons favourite music artist, however a plan to ensure this person listened to this music as part of their day has not been devised. This same care plan said this person liked a quiet environment. During this inspection the sat in a noisy room where people were exercising to music, where the hairdresser was working and where staff came in and out. During this inspection the activities co-ordinator led some exercises to music in the morning and in the afternoon some people played bingo. Other people watched TV in their own bedroom or in the lounge. People showed signs of well- being and those who wanted to walked around the home freely. We saw that visitors to this home are made to feel welcome and this is what people said in the surveys we sent. At the last inspection some people said they would liked to be helped to see the person they are visiting in private. We observed one person visiting for the first time who was not offered privacy for their visit. The food served at Thornfield is cooked on the premises and people say they enjoy it. Since the last inspection a second lunch sitting has been introduced. This means that lunch is now more relaxed, quieter, more sociable and it is easier for staff to meet peoples’ needs. Those people who need help get this from staff who were observed being gentle, attentive and sensitive to peoples needs. The cook reports that there are always two choices for lunch. However, some people were unaware of this and did not know what they were going to have until their food arrived. The manager reports that everyone is asked the day before what they would like and thinks they may have forgotten. People living here are very complimentary about staff but also say that some staff tend to make choices for them, give them things they think they would like or things that the staff like themselves. These choices do not always suit. Thornfield Care Home DS0000068262.V359755.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. Since the last inspection some staff’s ability in relation to interpreting behaviours as possible complaints has improved. People living here are safe. However because not all staff are following adult protection procedures people’s safety cannot be guaranteed. There have been considerable improvements in relation to ensuring that people have free movement throughout the home. Record keeping in relation to this needs further improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the complaints that have been recorded by the manager and found that there are few and that they are being dealt with appropriately. The commission have not received any complaints about this service since the last inspection. We saw in care plans that staff record when people who cannot easily communicate indicate by their behaviour that they do not like something and that appropriate action is taken. In addition we saw staff responding to Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 19 behaviours that indicate that the person wanted to do something different and staff responded to this sensitively and flexibly. We saw a member of staff skilfully prevent a potential issue between two people living here who have dementia. The outcome was such that each of these people was attended to and remained calm and in a state of ‘well being’. Staff say they have received training in ‘Safeguarding adults’ and demonstrate a good understanding of what abuse is and what to do if they suspect this. However, records seen in one care plan show that an event that should have resulted in safeguarding action being taken. We spoke with the manager who was unaware of this event and confirmed that no action had been taken. Since the last inspection the use of keypads to limit peoples movement throughout the home has been limited. Staff report that all internal doors are now usually left open. During this inspection we noted that in the afternoon one door was kept locked with the keypad. The manager explained that this door is being fixed as it will not remain open. Doors to the outside of the home have keypads to prevent people who might not be safe outdoors from leaving the home. At the last inspection we noted that records relating to how decisions are made about restricting people’s movement were not being kept. This has not yet been addressed as the manager and staff have yet to receive this training. Thornfield Care Home DS0000068262.V359755.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. The environment at this home continues to improve. The home is safe and clean. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home has employed a maintenance man who works at the home for four hours on four days each week. The manager reports that maintenance and any work needed is now being carried out quickly and efficiently. We noted that the hall flooring has been changed and is now more suitable for people with dementia type illnesses, and the stairs have been re-carpeted. The manager reports that a number of bedroom sets have been ordered and Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 21 there are new armchairs throughout the home. The call bell in the lounge is now more easily accessible and is working. All fire doors closed and the manager reports that works continues to ensure that the home meets fire regulations. The laundry is well organised and tidy. All areas of the home are clean. Staff were seen putting into practice good infection control procedures. Thornfield Care Home DS0000068262.V359755.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. The number of staff on duty ensures that peoples needs can be met. Work is ongoing to ensure that all staff continue to develop the skills needed to care for people with dementia. The recruitment procedures have improved and help to ensure that only suitable people work with this vulnerable group of people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection staff numbers have been reviewed and some increases made. Roles and responsibilities have been reviewed, some staff have been bought in from one of the company’s other homes and some staff have been redeployed. People visiting the home say that staff numbers are generally adequate to meet peoples needs although some would like more ‘one to one’ time for their relatives. staff are friendly. Each morning there is a manager on duty together with a care officer (who has overall responsibility for the shift) and at least 6 carers. In the afternoon there are usually 5 carers on duty. In addition there is an administrator, a cook, a Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 23 kitchen porter, a laundry person, a maintenance man (four days) and 2 cleaners. We saw that whilst the home remains busy, staff are much more relaxed and have time to spend with people. We spoke with staff who say that they feel well supported and that the changes made are helping them to meet peoples needs. They say that having dedicated staff for the laundry and cleaning means they have more time to spend with people. The manager has reviewed induction training and is ensuring that this covers all areas of training in care that is needed to ensure staff have the skills needed to care for people. In addition she has compiled a training matrix as a way of determining staff training needs. The home has a total of 23 carers of whom 4 have successfully completed the National Vocational Qualification (NVQ) in care. In addition 7 members of staff are working towards this. If these staff complete this training, this would bring the home in line with the national target of having 50 of care staff trained to NVQ level 2 or above. We spoke with the manager about our observations of interactions between staff and the people who live here. She is aware that some staff are very skilled whilst others have unmet learning needs. She has plans in place to address this with extra supervision, positive role modelling and training. In addition the manager is due to undergo a period of training in caring for people with dementia that will help equip her to train staff in this specialised area of care. We looked at the recruitment files of two members of staff who have recently been recruited. We found that all the checks necessary to help ensure that only suitable people work here are undertaken. This includes obtaining written references and carrying out a police check before each person starts to work at the home. Thornfield Care Home DS0000068262.V359755.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, 36 and 38. Quality in this outcome area is good. The overall management of this home has improved significantly. People living here are safe and their welfare is being promoted. All the changes and managerial decisions being made are ensuring that the home is run in the best interests of the people who live here. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection at this home there have been considerable managerial changes. One manager has left and another has moved to another home within the organisation. The current manager was the deputy here for only a short time and has been the manager here since February 2008. She is now applying to become the Registered Manager. Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 25 The manager says she is well supported by staff, senior managers and the owner. The Operations Manager visits each month to carry out an unannounced inspection and to form an opinion on the quality of care being delivered. In the short time she has been at this home the manager has become familiar with all the improvements required by the commission. She has set about addressing the identified shortfalls in a way that sets firm foundations for the future of this home. This is achieving improved outcomes for the people who live here. There have been improvements in care planning, the delivery of health, personal and social care, in the environment, peoples’ safety and in staffing numbers and skills. People who visit the home (both professionals and relatives) have noticed the programme of improvement that has been implemented and say they see changes and improvements. Staff say they feel well supported by the manager and that she is approachable and helpful. Some staff say she is recognising different skills of the staff and making changes accordingly. Some staff have been promoted and some staff have changed their roles to better suit their skills. Staff who require it receive extra supervision and this is recorded. The manager is currently studying for the Registered Managers Award and is due to attend an intense period of training in caring for people with dementia. Records show that all mandatory training is continuing and that some has been updated to ensure that all staff are familiar with for example fire procedures, moving and handling and infection control. Appropriate fire checks are carried out and the fire log was up to date. Any works identified by staff as needing attention had been undertaken. Since the last inspection formal quality monitoring by asking people for written feedback about the home has not been undertaken. However, verbal feedback from for example health care professionals is being asked for and acted upon. The home plan to carry out quality assurance processes when appropriate. In the meantime the home uses the feedback from the commission to help it improve outcomes for the people who live here. We looked at the way that money managed on behalf of two people who live here is managed. Good accounts are kept which are easily auditable. All monies spent have receipts and a copy of the account sheet is sent to relatives, where appropriate, for them to check. Thornfield Care Home DS0000068262.V359755.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 2 9 2 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 X X 3 X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 27 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 an appropriate and consistent way. The care plan must include how to meet the needs of people with dementia and should be person centred. Care plans must also help to ensure that people maintain the abilities they have for as long as possible. Each plan must be reviewed in a way that identifies changing needs, the effects of the care plan and which ensures that appropriate actions are taken. Previous timescale of 30/06/07 not met. Timescale of 31/01/08 partially met. 2. OP9 13 (2) Records relating to peoples medicines must be kept accurately to ensure that DS0000068262.V359755.R01.S.doc Timescale for action 31/08/08 30/04/08 Thornfield Care Home Version 5.2 Page 28 3. OP10 12 (4) (a) medicines are not abused. People living at the care home must have their privacy and dignity respected. This includes helping people to see their visitors in private if this is wished. Previous timescale of 31/01/08 partially met. 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 31/01/08 partially met. 30/04/08 4. OP12 16 (2) (m) (n) 31/07/08 5. 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. Previous timescale of 31/01/08 partially met. 31/08/08 6. OP18 13 (6) In order to safeguard the people who live here against potential abuse staff knowledge regarding what abuse is and regarding reporting mechanisms must be improved so that they would know how to use these if necessary. Previous timescale of 28/02/08 not met. 30/06/08 7. OP18 13 (7) (8) Decisions about any form of limitation of movement (restraint) must be made using DS0000068262.V359755.R01.S.doc 30/06/08 Thornfield Care Home Version 5.2 Page 29 the key principles of the Mental Capacity Act (2005) and records must show how these decisions have been arrived at. Previous timescale of 31/01/08 not met. 8. OP19 23 (4) People must be kept safe from fire by the home complying with the enforcement order issued by Devon and Somerset Fire and Rescue Service. 30/06/08 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 OP3 Good Practice Recommendations People with dementia who are admitted for respite care, should have a comprehensive assessment which forms the basis of their plan of care. In this way people can be supported to maintain their skills, abilities and independence. Each person living here should be helped to remain as continent as they can be. The home should continue to work towards ensuring that 50 of care staff hold a National Vocational Qualification (NVQ) in care. 2. 3. OP8 OP28 Thornfield Care Home DS0000068262.V359755.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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