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Inspection on 13/06/05 for Thornhill House

Also see our care home review for Thornhill House for more information

This inspection was carried out on 13th June 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides high standards of care and service provision, within an attractive and homely environment. The safety, dignity, and independence of service users is well promoted within their given capabilities and in accordance with their choices and lifestyle preferences.

What has improved since the last inspection?

There is ongoing commitment to maintaining and developing standards of care and service provision for service users. A review of care planning records had commenced with proposals to introduce a revised and updated format in accordance with recognised practise. A review of equipment provided in relation to individual service users continence needs was being undertaken, which included inputs and advice from outside healthcare specialist staff. A review of the induction/training and support arrangements for volunteers working in the home had been undertaken and a revised format introduced. Staff`s knowledge and understanding of recognised adult protection procedures had been updated and training had also been provided for staff in relation to infection control and dementia care.

What the care home could do better:

The Manager had identified areas for improvement and development, which included planned training in relation to creative working practises and care approaches via an outside trainer and also items identified above. There is clearly a pro-active approach to the ongoing development of the home.

CARE HOMES FOR OLDER PEOPLE Thornhill House Church Lane Great Longstone Derbyshire DE45 1TB Lead Inspector Susan Richards Unannounced 13 June 2005 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 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. Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Thornhill House Address Church Lane, Great Longstone, Derbyshire, DE45 1TB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01629 640034 John Thornhill Memorial Trust Care Home with Nursing 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 8th December 2004 Brief Description of the Service: Thornhill House provvides nursing and personal care and support for up to 16 older persons. It is purpose built single storey accommodation located in the village of Great Longstone, approximately 3 miles north east of the market town of Bakewell. The home is operated by the John Thornhill Memorial Trust, which is a registered charity. The home provides all single room accommodation with en suites to each. There is a choice of lounge and dining facilities and suitable bathing and toilet facilities. There is a central kitchen and separate laundry facility and a range of equipment both environmental and individual to assist those persons with physical disabilities, including an emergency call system throughout. The gardens are very well maintained and provide level access for service users, together with seating. Car parking spaces are also provded. The Registered Manager vacated her post in December 2004. There is now an acting Manager in post who is currently undertaking the fit person process for registration with the Commission. The Manager has the support of a team of nursing, care and hotel services staff, together with a significant number of volunteers from the local village and surrounding area. Close links are established with the local community, with a meals on wheels service operating from the home via volunteers. There is a friendly and homely atmostphere in the home. Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. What the service does well: What has improved since the last inspection? There is ongoing commitment to maintaining and developing standards of care and service provision for service users. A review of care planning records had commenced with proposals to introduce a revised and updated format in accordance with recognised practise. A review of equipment provided in relation to individual service users continence needs was being undertaken, which included inputs and advice from outside healthcare specialist staff. A review of the induction/training and support arrangements for volunteers working in the home had been undertaken and a revised format introduced. Staff’s knowledge and understanding of recognised adult protection procedures had been updated and training had also been provided for staff in relation to infection control and dementia care. Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 6 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. Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, & 5 Service users, who were able to converse, said the home met their needs and knew how these were being met and staff spoken to, was conversant with these. Individual care records were generally reflective of this, although there were some areas of omission of recording. The home is currently operating outside its registration category in relation to dementia care. EVIDENCE: Three service users were case tracked, although the inspector was not able to engage in proper discussion about the home and its service with one of the service users due to their capacity and level of confusion. This service user had a formal diagnosis of dementia, with previous documented care and input from psychiatric services via the Care Programme Approach (CPA). Staff had undertaken training in relation to dementia care and documentation and discussions with staff indicated that her needs were being well met. However, the home does not have the registration category of DE (dementia) on its certificate of registration. This was discussed with the Manager. One of the Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 9 service users had been more recently admitted to the home and that process was examined. There was a recognised approach for the admission of service users and for the standardised documentation of their individual needs assessments in accordance with a recognised model and internal policy guidance. The Acting Manager was in the process of facilitating a review of the assessment and care planning format and provided a template of the proposed format to be introduced. The Inspector is supportive of this and discussed the layout with the Manager. Staff did not always date and sign needs assessment documentation completed by them or detail regular reviews and there were some areas of omission in terms of the recording of information. However, discussions with service users and staff indicated that staff conversant with service users needs at that given time. Discussions with service users, relatives and staff indicated that there were suitable arrangements for admissions to the home. Records and written policy guidance were in place in relation to this. Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10. Service user personal and health care needs were being met, although staff did not always maintain consistent records in relation to care and medicines practise. EVIDENCE: Discussions with staff, service users and an outside healthcare professional indicated that individual’s personal and health care needs were being met. Service users had recorded care plans, which were formulated in a framework of risk assessment, although these were not always being reviewed at monthly intervals and were not always consistently recorded. However, the Manager had facilitated a review of the care-planning format and the revised format was being introduced. The Inspector will assess progress with this at the next inspection for this service. Lifestyle preferences and likes and dislikes were accounted for. There were clearly documented approaches to risk assessment in accordance with recognised practise for the care of older persons, including the risk of falls, nutritional and pressure ulcer risk and management. Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 11 The Continence Specialist Nurse from the health care community was visiting the home at the time of the inspection. Discussions with her indicated that she was assisting in the process of conducting a review of continence equipment to ensure that service users were in receipt of the right equipment. There were satisfactory arrangements in place for the regular access of service users to outside healthcare professionals for the purposes of routine healthcare screening and records of these inputs were maintained. The arrangements for the management and administration of service users medicines were examined. These were generally satisfactory, although a small number of requirements were identified in respect of administration and storage. Staff was observed to be mindful of service users needs and service users said that staff treated them with the utmost respect and care Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15. Service users were well supported in terms of maintaining and engaging in social and recreation activities of their choice and were provided with nutritious meals, in accordance with their needs and choices. EVIDENCE: The Inspector spoke with staff and service users about the arrangements for social and recreational activities in the home. The activities co-ordinator was present in the home during the inspection and was observed to be coordinating a newspaper group during the afternoon. A number of service users had been out to an antique fair during the morning and service users were also involved in the preparation of a well dressing. Service users spoken with said that they could choose activities to engage and that the arrangements were good. The home has excellent support from a significant number of volunteers/friends of the home, which promotes personal activities support both in and outside the home. Care records detailed service users hobbies and interests and their individual preferences and records were kept of activities that service users were involved in. Service users said they could see their visitor when they chose and in private. Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 13 The Inspector was invited to join a small group of service users for lunch. This was provided in a relaxed and organised manner and tables were suitably set. The quality of the food served was good and service users said they enjoyed the food provided and were able to choose and that likes and dislikes and dietary needs were met. Care records were reflective of this. Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18 Service users were safe and their rights were promoted. EVIDENCE: Service users spoken with knew how to complain and where to seek advice, although they said that any concerns they may have were always dealt with promptly without the need to make a formal complaint. The complaints procedure for the home only provided in a standard format – no alternative formats were available for those who may have sight difficulties. There were systems and recognised in place to promote the protection of vulnerable adults. Some service users had chosen to vote in the recent elections. Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 22, 23, 24, 25 & 26. The home provides a safe, clean and pleasant environment, which is well maintained and decorated to a high standard and suits service users needs. EVIDENCE: A number of areas of the home were inspected, including the private and communal accommodation accessed by service users. These areas were well maintained, in a good state of repair, furnished and decorated to a high standard and suitably equipped. Bedrooms were personalised and all areas seen were clean and hygienic. A requirement had been made at the previous inspection in relation to the need to review and replace carpets to some corridor and communal areas and a programme for this had commenced. Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Service users’ needs, was met by staff and volunteers working in the home. EVIDENCE: Details of staff employed, together with staff duty rotas were provided. These indicated the provision of adequate staffing. Service users spoken with said that their needs were being met. Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 The acting manager has not completed the fit persons process to be registered with the Commission. EVIDENCE: There has been a change of Manager since the previous inspection. The application by the acting manager to become the registered manager of the home is being processed by the Commission. A completed self-assessment questionnaire by her is outstanding – the application cannot be properly processed without the receipt of this. Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 x 3 3 2 3 x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 x x x x x x x Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 19 YES Are there any outstanding requirements from the last inspection? 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 OP19 Regulation 23(2)(b) & (d) CSA 2000 Pt 2, 28(1) Requirement Carpets must be replaced to the lounge/dining and conservatory areas. From inspection 08.12.04 - original timescale 01.05.05 The homes certificate of registration must reflect the category of service users accommodated. The registered person must make an application for a variation to registration in order to continue to accommodate the identified service user with dementia. All relevant needs assessment information must be clearly documented for each service user and reviewed at least monthly. Staff responsible must always sign for medicines administered or record the appropriate coded reason for not doing so. Where a variable dose is indicated for a prescribed medication, staff responsible must record the actual dose given. Medicines requiring refrigeration must be stored in a separate locked refrigerator suitable for the purposes of storing Timescale for action 30.09.05 2. OP31 31.07.05 3. OP3 14(1) & (2) 31.07.05 4. OP9 5. OP9 13(2) & 17(1)(a), Schedule 3 13(2) & 17(1)(a), Schedule 3 13(2) 30.06.05 30.06.05 6. OP9 31.08.05 Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 20 medicines. 7. OP31 9(2) The Acting Manager must complete the fit persons process for registration under the Care Standards Act 2000. 31.07.05 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 Staff responsible must ensure that they sign and date all needs assessment and care planning records on completion. Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 21 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road Derby, DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Thornhill House C52 C02 S2093 Thornhill House V232433 130605 Stage 0.doc Version 1.30 Page 22 - 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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