CARE HOMES FOR OLDER PEOPLE
Thornlea Rest Home 308 St Annes Road Blackpool Lancashire FY4 2QP Lead Inspector
Mrs Ruth Edgington Unannounced Inspection 6th February 2007 09:45 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 Thornlea Rest Home DS0000009737.V308404.R02.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. Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Thornlea Rest Home Address 308 St Annes Road Blackpool Lancashire FY4 2QP 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) 01253 345574 01253 406568 www.thornlearesthome.co.uk Mr Timothy Davies Wood Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The service is registered to accommodate a maximum of 15 service users in the category OP (older persons 65 and over) to include Up to 15 service users in the category OP (older persons 65 and over) Up to 1 service users in the category PD (Adults with Physical Disability) 8th December 2005 Date of last inspection Brief Description of the Service: Thornlea is a large detached bungalow situated in a residential area of South Blackpool, on a main road, which is an advantage in respect of public transport and local amenities. The home is registered to accommodate a maximum of 15 persons aged 65 years and over. However permission has been given to include one named person under this age. The accommodation consists of 13 single bedrooms and one double bedroom, none of which have en-suite facilities. There are two lounges and a dining room. The bathing and toilet facilities are sufficient to meet the number of residents accommodated. Sufficient information about the home is provided to all prospective residents in order that they can make an informed decision about the care and service provided. The home has a Statement of Purpose and Service User Guide containing information about the care provided, the qualifications and experience of the owner and staff and what services residents can expect if they choose to live at the home. This information is displayed in the hallway of the home along with a copy of the last report from the Commission for Social Care Inspection for anyone to read. Information received (25/10/06) from the homeowner showed that the fees for care at the home ranged from £285.04 to £329.91 per week, with added expenses for hairdressing, newspapers and chiropody. Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced site visit was undertaken as part of the home’s Key Inspection. The site visit commenced at 9.45 am and took place over 4.30 hours. Prior to the visit the homeowner completed a pre-inspection questionnaire, which provided information about the residents, staff and other information, which assisted in assessing how the home was meeting the National Minimum Standards. Comment cards had been sent out prior to the visit and in total four relatives and one general practitioner returned these to express their views about the service. During the visit three residents, three members of staff and the deputy were spoken to individually. A tour of the home was carried out during which a number of residents were also spoken to. A random selection of residents, staff and administrative records were looked at and discussions took place with the homeowner. From observations made, comments received and written documentation examined, the information has been put together to produce this report. What the service does well:
This is a care home where the residents are looked after well. The homeowner and staff team were seen to be very caring in the way that they looked after the residents. Observations of care practices throughout the visit confirmed that residents were treated with respect and dignity. The residents are able to mix with others in the home or have their privacy whenever they wish. They are encouraged, within their capabilities, to be individual and their personal routines and lifestyles are respected. From observations and discussions during the visit, evidence was gained to confirm that the homeowner and staff had a good understanding of equality and the diverse needs of the residents, which ensured that their individual needs were met. On previous visits to the home it was noted that one resident who by exercising their right to control their own life was causing staff to be concerned for this persons safety. It was reassuring to find on this visit that through support and understanding the concerns had been resolved whilst enabling the resident to continue to exercise control over their own life. Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 6 Comments received from one general practioner confirmed that the staff communicated clearly and understood the care needs of the residents. Comments received from relatives indicated that overall they were satisfied with the care provided. One relative spoken to said that the staff were very kind, they were made welcome and there was always some to speak to if they had any questions in relation to the individual resident. There was a very relaxed atmosphere in the home with a lot of affectionate banter between the residents and staff. What has improved since the last inspection? What they could do better:
Staff recruitment procedures must be followed correctly at all times to ensure that the residents are fully protected. Staff must not be employed until all clearances, references and full employment history have been obtained. The homeowner was reminded that checks carried out through (POVA) Protection of Vulnerable Adults only enable staff to commence employment if they are supervised at all times until a satisfactory disclosure is obtained through the CRB (Criminal Records Bureau). Proposals to improve the laundry facilities by providing a new laundry room would not only benefit the staff but would ensure that the home continues to provide a clean, hygienic environment free from offensive odours.
Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 7 From observations and discussions during the visit evidence was gained that there was a recognition that there was always room for improvement and the need to continually strive to ensure that each individual resident’s needs were fully met by the service and care provided in the home. 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. Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission and assessment procedures were clear to ensure the care needs of residents are met. EVIDENCE: The admission procedure of the home ensures that a formal assessment is carried out prior to any resident being admitted and that the prospective resident or their relative is informed in writing that the individual’s assessed needs can be met. This was confirmed through examination of the files of three residents who had been admitted to the home since the last visit. Staff confirmed that prospective residents are encouraged to visit the home if possible and stay for a meal. During this visit an assessment of their needs is carried out and any concerns are answered in order that they can make an informed decision about the service provided and how their needs will be met. Alternatively the homeowner or deputy will visit the prospective resident to discuss their needs and carry out an assessment.
Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 10 A prospective resident came to the home for lunch and confirmed that they had visited on several occasions and were eager to come to live at Thornlea, however there were no vacancies at the time and they were also waiting for an agreement from the local authority with regard to assistance with funding. Comments received from residents and relatives confirmed that they had received enough information about the home before they decided to move in and always received the care and support that they needed. From discussions with the staff on duty, observation and examination of daily records, evidence was gained that the staff were very aware of the individual residents needs and had access to the residents’ information. This home does not provide intermediate care. Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9&10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care, which a resident receives is based on their individual needs. The principals of respect, dignity and privacy are put into practice. EVIDENCE: Information is recorded on each resident using a system that covers their health, personal and social care needs. This documentation also includes risk assessments in relation to nutrition and mobility. The dependency level of each resident is also documented. The records of the three residents already identified were looked at in detail and evidence was seen that either they or their relatives had been involved in agreeing the care provided. Care plans are reviewed on a monthly basis and entries are made of any changes to the care given and other matters relating to the residents’
Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 12 individual needs. Significant events were also recorded, which included visits by their doctor, district nursing service and referrals to other professions. Discussion with staff members on duty confirmed they were fully aware of the healthcare needs of residents and that these were monitored and their care plans kept up to date. Throughout the visit observations were made of the caring approach of the staff towards the residents and the practices in the home ensured that residents were treated with respect and their right to privacy was upheld. The comments received from residents and relatives about the care that they received were very positive. One relative who visits each week said that they were very satisfied with the care given. They confirmed that the staff kept them informed of any changes affecting the individual resident and the care plan was available for them to see if they wished to. One resident spoken to said that they were very happy and the staff looked after their every need. Medication practices observed were safe and good records had been maintained. The staff members responsible for the administration of medicines had received training to ensure they had basic knowledge of how medicines are used and how to recognise and deal with problems. The documentation seen included information in relation to each person’s medication, what they were for and any side affects. The local chemist used by the home is very supportive and available to offer advise if required. Through discussions with the staff evidence was gained to confirm that they are made aware of any information produced by the Medicines and Healthcare products Regulatory Agency (MHRA). This information brings to the attention of care providers concerns that have been identified and any action that staff need to take to protect the heath of the residents. Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 13 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): All the above standards were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive a healthy and varied diet according to their assessed needs and choice. Social, cultural and recreational activities meet resident’s expectations. EVIDENCE: On each individual resident’s file there was information in relation to his or her social, cultural, religious and recreational interests and also there was information about their life history, which all assisted in identifying how their needs could be met. Residents spoken to said that they were able to make decisions about how they lived their lives. From comments and observations made, confirmation was gained that the home promoted equality by treating residents as individuals and ensuring people with diverse needs were having these met. Every afternoon an activity is arranged for those residents who wish to join in and in some instances time is spent on an individual basis. A list of the daily activities for any given week is located in the entrance hall of the home for visitors to see. One visitor spoken to said that their relative was not keen on
Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 14 activities but would watch the television sometimes, however they did like to join in when an entertainer came to the home, which was frequently. Some residents were watching television; two residents were going out to the local day care facility, which had been arranged for them to maintain links with the community. One resident who likes to go out said that they did not think they would go that day as it was very cold. However later they went out with a member of staff. Visitors are encouraged to visit at any time and this was confirmed through discussions with one relative visiting at the time. Residents spoken to said that they enjoyed their food and they were observed having their breakfast and lunch in a relaxed manner, staff did not hurry them and were on hand if they required assistance. One resident said that they had enjoyed their breakfast and had eaten plenty. The records of one resident indicated that they liked fish and they were observed enjoying fish for their lunch, which they had chosen in preference to the menu. The home has a very pleasant, friendly atmosphere. Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 15 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for complaints are handled well and taken seriously ensuring people feel listened to. Procedures for dealing with and reporting abuse were satisfactory ensuring people are adequately protected. EVIDENCE: The home has a complaints procedure that provides good information. A copy of the procedure is displayed in the hallway and is also included in the information contained in the Service User Guide, a copy of which is in each bedroom for residents and their relatives to refer to. Comments received from relatives confirmed that the majority were aware of whom to complain to if they had any concerns. The home has a procedure in place for dealing with allegations of abuse. The homeowner and staff spoken to had a good understanding of the procedures to be followed in the event of any allegations or suspicion of abuse or neglect. Staff spoken to confirmed that this issue was covered during their NVQ (National Vocational Qualification) training. Since the previous visit to the home, the Commission for Social Care Inspection (CSCI) had received one complaint that was then referred to the homeowner to look into. This was dealt with to the satisfaction of all concerned.
Thornlea Rest Home DS0000009737.V308404.R02.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): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a safe, comfortable and homely environment. EVIDENCE: A tour of the home confirmed that there had been a great deal of work put into improving the standards since the last visit. Redecoration and refurbishment throughout the home was evident. The residents’ bedrooms were very cheerful and personalised with their own possessions and all bedrooms had been fitted with flat screen televisions. New televisions had also been fitted in both lounge areas, which the residents confirmed were an improvement. The assisted shower room that was in the process of being provided on the last visit to the home was completed and comments made confirmed that this was well used by the residents. Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 17 The homeowner stated that he was considering making improvements to the laundry facilities by making a new laundry room, which would be more appropriate placed for staff to use and was to purchase new equipment that continued to meet all the requirements. The home was found to be warm, clean and free from any obvious hazards providing a pleasant environment for people to live. Work had also been undertaken to improve the outside of the home. The front garden had been landscaped, which made a welcoming impression to anyone coming to the home. The rear garden had also been landscaped and a seating area provided for residents to enjoy sitting outside in better weather. The homeowner said that he wanted to provide a ramp to the side of the home, which would benefit residents with mobility problems as at the moment they use the ramp to the rear of the home if required. Additional storage space has been provided outside for the storage of equipment not currently required in the home. Thornlea Rest Home DS0000009737.V308404.R02.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): All the above standards were looked at. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in the recruitment procedures could potentially put residents at risk. Staff are trained, competent and sufficient numbers to meet the needs of the residents. EVIDENCE: The files of the three care staff were looked at in detail and it was noted that in two cases the correct recruitment procedures had not been followed. Staff had commenced work before clearances had been received through POVA (Protection of Vulnerable Adults) and the CRB (Criminal Records Bureau). A reference obtained for one member of staff was unsatisfactory and there was no written evidence available to confirm that the homeowner had discussed this with the member of staff and why he had chosen the employ this person. It was also noted that there were short lapses in this member of staff’s employment history, which had not been looked into. Examination of the records of a new member of staff who was due to commence work shortly indicated that the correct recruitment procedures had been followed. The homeowner confirmed that the shortfalls had been
Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 19 recognised and recruitment procedures would continue to be followed correctly in the future. A number of staff employed in the home have worked together in other homes and those spoken to said that they had been delighted to be offered the chance to work together again. Confirmation was seen that all staff undertake a formal induction process to ensure that they are made familiar with the needs of the residents and the policies and procedures of the home. Evidence was seen to confirm that the staff group have a great deal of experience working in a care setting and have undertaken a variety of training and gained qualifications required for their post. Over 50 of care staff have achieved level 2 NVQ or equivalent. Three staff members hold a nursing qualification. Staff said that they were supported and could ask the homeowner or deputy for anything that they required to ensure that the needs of the residents were met. One staff member said that they loved working at the home, the staff group worked well together for the benefit of the residents. From discussions with the staff they were able to demonstrate their commitment to providing a good service. Examination of staff rota’s indicated that there were sufficient staff on duty at any one time to meet the needs of the residents accommodated. Comments made by residents indicated that they were satisfied with the care that they received and felt that the staff were very caring and did a good job. From observations made during the visit evidence was seen of the caring nature of the staff and the positive interaction with the residents. Thornlea Rest Home DS0000009737.V308404.R02.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): 31,33,35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed for the benefit of the residents. EVIDENCE: The homeowner is very involved on a daily basis and has the experience and qualifications required. He is supported by a deputy who is very competent and experienced and who has taken over responsibilities in relation to meeting the needs of the residents and also issues relating to staff. Staff and residents spoken to all said that they found the homeowner very approachable and committed to ensuring that the needs of the residents came first. Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 21 Information gained from the Pre-Inspection questionnaire and examination of service records during the visit, confirmed that all equipment and systems are regularly serviced and up to date. Systems are in place for quality assurance. The views of residents, relatives and visitors are obtained through the use of questionnaires, which are available to them in the entrance to the home. Their comments provide the homeowner with an overall view of the service provided in order that the needs of the residents continue to be met appropriately. The home holds the IIP (Investors in People) Award, which is an external quality award that demonstrates the owner’s commitment to staff training and development. All policies and procedures are in place and reviewed on a regular basis. Evidence was seen that the policies include information covering issues relating to equality and diversity and that the staff and management team had a good understanding of how this affects the lives and care required for individuals. A record is kept of all monies handled by the homeowner on behalf of the residents and all monies and records are kept securely locked up, with access limited. The homeowner informs CSCI of any issues that affect the wellbeing of the residents. Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 22 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 Requirement The registered provider must ensure that the recruitment procedures are complied with fully to ensure that residents are safeguarded. Timescale for action 26/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP26 Good Practice Recommendations The registered provider should undertake the proposals to improve the laundry facilities by providing a new laundry room would not only benefit the staff but would ensure that the home continues to provide a clean, hygienic environment free from offensive odours. Thornlea Rest Home DS0000009737.V308404.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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