Inspection on 24/01/07 for Thornhill House

This inspection was carried out on 24th January 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Thornhill House 22/12/09

Thornhill House 19/09/07

Thornhill House 10/10/06

Thornhill House 07/12/05

Thornhill House 13/06/05

Thornhill House 08/12/04

Thornhill House 09/06/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Thornhill House Church Lane Great Longstone Derbyshire DE45 1TB Lead Inspector Susan Richards Key Unannounced Inspection 24th January 2007 09:30 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 Thornhill House DS0000002093.V327784.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. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thornhill House Address Church Lane Great Longstone Derbyshire DE45 1TB 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) 01629 640034 John Thornhill Memorial Trust Catherine Elizabeth Headington Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration to include the accommodation of two named service users (as specified on the notice of proposal) at Thornhill House under the category DE,E - not transferable to any other service users, other than those as named. The maximum number of persons to be accommodated at Thornhill House is 17 10th October 2006 2. Date of last inspection Brief Description of the Service: Thornhill House is operated by a registered charitable trust whose patron is the Duchess of Devonshire. The home provides nursing and personal care and support for up to 17 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 provides all single room accommodation with an en suite facility 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 provided. The Registered Manager has the support of a team of nursing, care and hotel services staff, together with a number of volunteers from the local village and surrounding area. External support is also provided via the charity’s board of trustees. There are excellent arrangements to enable residents to engage in activities of their choice, which are planned by the activities co-ordinator employed. Close links are also well established with the local community and there is a meals’ on wheels service, which also operates from the home via employed volunteers. The current range of charges per week is from £515.00 (personal care only) to £647.00 (higher dependency nursing). Fees are determined in accordance with individual’s assessed needs detailed by way of individual written terms and conditions for those who are funded by social services arrangements in contract with the home, or by way of written contracts between the home and individual where these are private funding arrangements. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second key inspection of this service during the inspection year 2006-07. This report considers all information the Commission holds about the home, particularly over the last twelve months, including the last inspection report, information provided by way of a pre-inspection questionnaire completed by the manager in October 2006 with returned service user surveys (five out of ten returns), and also this site visit to the home 24 January 2006 Case tracking was used a part of the methodology. This involves random sampling of a small number of service users (three in this instance), whose care is examined more closely. This includes inspection of individual’s written care plans and associated care records and discussions with them, where possible, and/or their representatives and also staff about the care and services they received. The private and communal accommodation of those service users is also inspected. What the service does well: What has improved since the last inspection? Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 6 Recorded needs assessments are in place for each service user in accordance with a recognised assessment model. Service users are now protected by the home’s recruitment practises. Ensuring that the fitness of staff to work in the home is properly determined before they commence their employment their. There is a registered manager in post. A formal quality assurance and monitoring system is established. Records of being properly kept in respect of staff recruitment and employment, service users needs assessments and staff induction. 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 be made available in other formats on request. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 3, 4 & 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users needs are clearly determined and well met. EVIDENCE: Case tracking was undertaken for three service users, and individual’s care needs were discussed with two of those. Each of their recorded needs assessment information was well recorded and comprehensive in accordance with a recognised assessment model, including that relating to risk assessment. Relevant pre-admission information was also recorded. Individual’s daily living arrangements, lifestyle preferences and preferred routines were accounted for. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 9 At the previous inspection of this service in October 2006 a requirement was identified to ensure that there is always a fully recorded and up to date needs assessment in place for all service users. This is complied with at this inspection. Also at that previous inspection there were two service users accommodated who were in receipt of intermediate care. Each had their own equipment and supportive links and inputs with outside specialist services and relevant healthcare professionals, including occupational and physiotherapists. Discussions were held with one of those service users at that inspection, who expressed high levels of satisfaction with the care and services received in respect of their rehabilitation and was looking forward to returning home. Since that inspection, that person had successfully returned to their home, and continued to visit the home each week for lunch club. Discussions held with the manager and staff about individual’s assessed needs and also their own experience, knowledge and training determined that staff were highly conversant with service users needs and well able to meet them. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health, personal and social care-needs are well met and they are treated with the utmost dignity and respect. EVIDENCE: The arrangements for service users care and support were discussed with a number of service users, including staff’s approaches with them, which were also observed during the course of the inspection. Service users and their representatives, expressed high levels of satisfaction regarding the quality of care they received and staff’s approaches. All said they were treated with the utmost dignity and respect at all times and that staff listened to them and on the whole, were conversant with their daily living/lifestyle preferences and preferred routines. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 11 The written care plans of service users case tracked were examined. Care plans adequately documented individual’s required care interventions in accordance with service users risk assessed need and the nursing process. They were reflective of evidence based clinical practise and were up to date. The extent of service users formal involvement in their care plans and reviews were unclear as there was no documentary evidence of this, although individual’s said that staff did talk with them about aspects of their care. However, the manager advised that a review of the care planning format had recently been undertaken with a revised format due to be introduced over the coming weeks, to be used for all existing service users and also any new admitted to the home. An example of this was provided. This was to include a recorded format for service users who are able to sign their agreement with their care plans, although the arrangements regarding this in respect of care plan reviews and ongoing consultation with service users was not clear. Records were maintained in respect of the arrangements for each service users access to outside health care professionals, including for the purposes of routine health care screening and service users confirmed their access to these. The arrangements for the management and administration of the medicines of those service users case tracked were also examined. These were satisfactory and in accordance with recognised practise. The inspection report of the last inspection of this service in October 2007 made a recommendation to develop written policy guidance relating to the self-administration of medicines by any service user, which was particularly relevant in respect of the rehabilitation of service users accommodated that time. This was successfully achieved. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users rights to live meaningful lives in accordance with their known lifestyle preferences, choices and given capacities are well promoted as is the importance of good nutrition for older persons. EVIDENCE: Discussions were held with service users about the arrangements for them to engage in leisure, social and religious activities and to maintain their personal and social relationships. Feedback in respect of these was positive. The activities co-ordinator employed is long established and has good rapport with service users. Care is taken to organise a variety of activities, which as far as possible are tailored to individual’s choices and lifestyle preferences, Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 13 both in an outside the home and there is excellent support from a significant number of volunteers. The home has a very welcoming, lively and friendly atmosphere and has well established links within the local community and information is available in the home regarding access to advocacy services. Food is provided to a good standard with local produce, fresh ingredients used. Great care is taken in the setting, serving and presentation of meals and also in assistance for service users. All spoken with said the standard of food was excellent with daily consultation and choice. There were no service users with special religious or cultural dietary needs. Special diets are catered for and the nutritional status of each service user is assessed and monitored with records maintained in respect of these. The manager advised that a review of menus was due to take place in conjunction with dietetic advice concerned with nutrition for older persons. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems and arrangements in place regarding of the protection of service users from abuse and their rights to complain are satisfactory. EVIDENCE: There is a written complaints procedure for the home, which is displayed. Service users spoken with were able to identify what they would do if they wanted to make a complaint. However, most said that any issues raised were usually dealt with without the need to complain. A record of complaints is maintained and there were plans to introduce an improved format of record keeping in respect of complaints. There had been one complaint over the last twelve months, which was resolved. This complaint was not of a serious nature. Discussions with staff regarding the prevention and recognition of abuse indicated that they had received relevant training and were conversant with Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 15 procedures to follow in the event of any witnessing or recognition of abuse of any service user. The arrangements for the management and handling of service users monies were not examined at this inspection, but at the previous inspection of this service in October 2006 these were satisfactory. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 16 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): NMS 19, 24 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users live in a safe, clean and comfortable and well-maintained environment, which provides purpose built accommodation to the satisfaction of service users accommodated. EVIDENCE: The private and communal accommodation of service users case tracked was inspected and all areas seen were furnished and decorate to a high standard. The home is well maintained, safe, clean and comfortable, well lit and ventilated. Service users expressed satisfaction with their own rooms. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 17 There is a separate laundry facility, which is suitably equipped and separate sluicing facilities, including a mechanical sluice. The home is purpose built and of single storey accommodation with full disabled access. There are two service users with dementia, who are able to wander safely. Over the last twelve months there has been ongoing redecoration and renewal to the fabric of the home, which is planned continually and storage facilities, which are not at a premium is under review. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 18 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are effectively supported and protected by the numbers and skill mix of suitably trained staff and by the home’s recruitment practises. EVIDENCE: Details of staff employed, staff turnover and the arrangements for their recruitment, induction, training and deployment were discussed with the manager and staff and associated records were examined. At the two previous inspections of this service (December 2005 and October 2006) serious concerns were raised separately in writing regarding unsatisfactory recruitment procedures, with a significant number of staff being employed before satisfactory confirmation of their fitness to do so. During that same period a high number of agency staff were being used, which together with management changes impacted on the service. The staff group is now stable and agency staff is no longer required on a regular basis. Proper procedures are also being followed in respect of staff recruitment and staff morale is good. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 19 A discussion was held with the manager regarding records and checks to be obtained to ensure staff are fit to work in the home. The Inspector reconfirmed with her that CRB certificates are not portable between employers (since June 2004) in accordance with joint guidance issued by the Commission and CRB. Also at the previous inspection of this service a requirement was made regarding staff induction and the lack of record keeping in respect of these. Records of the two most recent staff starters were examined and these contained suitable records. Staff said that access to training was good, which training records confirmed. On the day of the inspection visit, the NVQ assessor was present in the home. There are in excess of 65 of staff with at least NVQ level 2 or above with further undergoing this, including two staff NVQ level 3, four staff NVQ level 2 and one doing NVQ level 4. Further dementia care training was also booked for staff during February 2007, with almost all staff now having undertaken this. Future training planned also included palliative care (four staff to attend) and diabetes training and updates for all staff. Other areas of staff training over the last twelve months have included, core training to ensure safe practise, extended nurse role training – venepuncture, clinical updates and dementia care. One person had undertaken a certificate in counselling skills and theory and one training in activities for older persons and reminiscence skills training. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 20 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): NMS 31, 33, 35, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are clear improvements with regard to the management and administration of the home, with a re-establishment of its former consistent and robust approach in this area. EVIDENCE: Since the previous inspection, the manager’s registration application, submitted to the Commission on 05 October 2007, has been approved for Thornhill House. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 21 Thornhill House has a consistent history of being well managed, with the exception of the 18 months leading up to the last inspection of this service, where after many years of management stability there have been two changes of registered manager in fairly quick succession. During this period and as detailed in the report of the previous inspection of this service, there were a number of matters arising relating to areas of poor management and administration, including that relating to aspects of record keeping, staff recruitment practises and written notifications of deaths which must be provided to the Commission in the event of the death of any service user. In addition a requirement was made to establish a formal quality assurance and monitoring system for the purposes of reviewing and improving the quality of care and services provided at the home, to include and re-establish formal consultation with service users and their representatives. At this inspection, we were advised that there have been some changes of membership to the trust board and along with this a review of management roles and responsibilities is to commence. Clear and swift improvements have been made in respect of the management and administration of the home with regard to the areas stated above, which were completely satisfactory at this inspection. Outside consultancy had also been commissioned for the purposes of undertaking a full quality assurance audit of the home, its care and service provision. It is understood that this had recently been completed, with future monthly internal audits to be carried out by the registered manager, based an a defined system of quality monitoring, although a written annual development plan was not yet formally established and agreed by the home (which reflects aims and outcomes for service users). Also since the last inspection, the Commission has approved Catherine Headington as registered manager for the home, following her application of 05 October 2006. As part of the management review of the home, regular staff meetings, a named nurse/key worker system and a system of individual staff supervision were re-established with a relatives group is to be commenced. Mechanisms for the ongoing and formal consultation with service users about the services they received were not established during this inspection. This also applies to methods for engaging other stakeholders (ie GPS, professionals allied to medicine, voluntary staff) as to how the home is achieving its goals for service users. Details of policy and procedural guidance were provided by way of the preinspection questionnaire. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 22 The arrangements for the management and handling of service users monies, was not inspected on this occasion. These were satisfactory at the previous key inspection in October 2006. Systems and arrangements in respect of ensuring safe working practises in the home were also examined. These included staff training, service and maintenance of equipment, storage of hazardous substances, security of the premises and also of service users based on their vulnerability, including risk management strategies and accidents/incidents. These were satisfactory and staff was conversant with their roles and responsibilities and that of their employer in respect of these. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 4 X 4 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X 4 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 3 3 Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 24 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 OP33 Regulation 24 Requirement Systems for reviewing and improving the quality of care and services provided by the home must provide for ongoing consultation with service users and their representatives. Timescale for action 31/03/07 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. 2. Refer to Standard OP15 OP33 Good Practice Recommendations Wherever possible, service users should be actively involved in their care plan reviews and a record should be kept of their involvement/consultation with these. There should be a written annual development plan produced for the home based on it proposed audit cycle, which reflects aims and outcomes for service users. Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derby Area Office Cardinal House, Cardinal Square Nottingham Road Derby DE1 3QT 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 Thornhill House DS0000002093.V327784.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!