Random inspection report
Care homes for older people
Name: Address: Thornton Hall & Lodge Tanhouse Road Liverpool Merseyside L23 1UB two star good service 18/05/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Patricia Thomas Date: 1 6 1 1 2 0 0 9 Information about the care home
Name of care home: Address: Thornton Hall & Lodge Tanhouse Road Liverpool Merseyside L23 1UB 08456044972 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Paul Ashmore Type of registration: Number of places registered: Conditions of registration: Category(ies) : Thornton Hall & Lodge care home 96 Number of places (if applicable): Under 65 Over 65 48 48 dementia old age, not falling within any other category Conditions of registration: 48 0 The registered person may provide the following category of service only: Care home only- Code PC. To service users of the following gender: Either whose primary care needs on admission to the care home are within the following categories:Old age not falling within any other category - Code OP (maximum number of places: 96) Dementia - Code DE (maximum number of places:96). The maximum number of service users who can be accommodated a the care home is 96. Date of last inspection Brief description of the care home Thornton Hall and Lodge is registered to provide care for up to 96 older people. The home can provide care to older people who have dementia as part of their registration.
Care Homes for Older People Page 2 of 10 1 8 0 5 2 0 0 9 Brief description of the care home The home is owned and managed by Orchard Care. The home is new and was purpose built. As such the home environment meets requirements in relation to size, facilities and aids and adaptations. The home and grounds are fully accessible to people who are physically disabled or who use a wheelchair. The home is a two storey building and access to the first floor can be gained via stairs or a passenger lift. The rear garden is large and is landscaped for ease of use by the people living at the home. The home is currently divided into four seperate areas each accomodating twenty four people. Each area offers three lounges, a large dinning room and satellite kitchen area. There is also a communal hairdressing salon. The fees for residing at the home range from £389 to £585 per week. Care Homes for Older People Page 3 of 10 What we found:
We carried a random inspection over two days, on 16th and 23rd November 2009. This was to gather information from the home in relation to an investigation being conducted by the safeguarding team. We used a system called case tracking to check that people are receiving the care and support they need in this home. This is a way of inspecting that helps follow particular aspects of need to ensure the right support is being given to the person. We found that the home has good systems for gathering information about peoples needs and for recording them. Although care records follow a standard format, in some instances, information was not being used effectively to update peoples care needs. For example, for a person receiving treatment for a pressure sore there was no update on their wound chart as to the progress of the treatment being given by district nurses. Staff need to keep accurate records about each persons condition so that their care plan can be altered to meet any change in their needs. Pressure care support plans should include monitoring of fluids and nutrition so that all areas of risk are being identified, recorded and clearly addressed in the persons care plan. We found that support from health professionals and the outcomes was not always well recorded by staff, (for example) in two instances outcomes of a doctors and a community psychiatric nurses visits had not been updated, which could mean that people may not be getting the support they need. In three out of the four care plans looked at, the records tell us that the people have lost weight. There were instructions to report weight loss to senior staff in one care plan, but no records of referrals to G.P. or dietician. We looked at the care records of a person who has diabetes and found there was no diabetic care plan in place. The support the person was receiving, for example for foot care, diet and nutrition and pressure sore prevention, had been written about in different parts of the care records and were difficult to track. There was no record of the person having been referred to an optician since moving in and, due to the way care records are managed, this could be overlooked. In discussion with the area manager for the service and the registered manager, we found that they have identified shortfalls in care management competence and work was in progress to provide staff with mentoring and guidance on care planning. This means that management are taking action to improve standards in the home and give staff the support they need. We looked at the homes medication arrangements following receipt of concerns about the administration of medicines. Overall, we found that action was being taken to improve medicines handling at the service but there were weaknesses that need to be addressed to reduce the risk of errors and to help ensure that the safe handling of medication is better supported. We compared a sample of medicines stock and records. We found that medicines in the monitored dosage system where generally given correctly. We checked a sample of medicines contained in packets and bottles and found the occasional discrepancy where records showed more tablets had been given than had gone from stock. We were concerned to find that where medicines needed re-ordering outside the normal monthly ordering cycle, people were at risk of missing doses of medication because there were
Care Homes for Older People Page 4 of 10 none left. We saw three examples where people had missed doses of medication this month because they had none left in stock. We asked about the arrangements made to ensure special label instructions such as before food were followed. Staff spoken with explained that they knew which people needed to have medicines before breakfast and made sure they had their medicines first. However, this reliance on memory increases the risk that these special instructions will be missed. We saw that one person had missed a dose of medicine because they had already eaten. Consideration should be given to these arrangements to help ensure that medicines are given at the best and right times for people at the service. Most medication administration records were pre-printed by the pharmacy these were generally clearly completed, and also showed the receipt of medicines into the home. But, it was of concern that where handwritten administration records were used or handwritten alterations made some were less well completed. These entries and amendments were not checked and countersigned by a second person. This increases the risk of making mistakes. It was of concern that records were not always made to show the application of prescribed creams making it impossible to tell whether these were being applied as needed. We found a lack of information about the use of creams within peoples care plans. Similarly, written guidance about the use of when required medicines and when they may be needed was not always available. It is important that any advice about the use of when required medicines is clearly recorded to help ensure they are correctly used. We saw that regular medicines audits were carried out and additional training in medicines handling had been completed. Where concerns were identified they were investigated by the manager to try and reduce the risk of re-occurrence. People have night care plans and records show they need checks throughout the night as well as having their medication given and support for their personal care and continence. Given the high level of support needs of some of the people who live in this home, night staff numbers should be monitored by management with a view to bringing in extra staff if needed. This will help to ensure there are always enough staff to support people properly and safely in their home. Training records show that the majority of staff have had infection control training or updates recently. Further training for three members of staff had been arranged for December 09. There are infection control systems in place in the home and staff have clear written guidance on this in the procedures in place for keeping the home clean and free of infection. Staff were wearing different colours of protective clothing depending on their duties, for example, for serving meals, domestic duties and cooking. Cleaning materials are colour coded and there are good systems in the laundry and kitchen to avoid contamination. Staff who were spoken with understood hygiene and infection control procedures and the home was clean and hygienic in the areas which were seen during our visit. What the care home does well:
It was evident in care records that staff have taken time to find out about peoples interests and religious needs. This is done so that the home will be able to continue to support people with the things that are important to them after they move in. People who live in the home said there is often a religious service and priests and ministers visit
Care Homes for Older People Page 5 of 10 regularly. One person said that keeping up with her religion is very important to her and the arrangements in place are appreciated. Staff had found out about about when people like to get up and go to bed, where they like to have their meals and what they like to eat. Their preferences in this and how to support them had been written in their care plans. People told us they spend time as they choose in their home and their preferred daily routines are respected by staff. Six people we asked about food said the meals are good. Meals are brought in heated trolleys from the central kitchen to each unit. We observed the meal being served on the dementia unit. This was carried out in a relaxed and helpful manner by staff and people were being offered choices and alternatives to the menu and were served hot and cold drinks before and during the meal. People we met who live in this home looked comfortable. One person said a relative arranges appointments for her with the doctor and goes with her. She said she has her own personal phone line from her bedroom and has very good contact with her family. She said her visitors are made welcome and she thinks her bedroom is comfortable and likes having an en-suite. Another person told us they had moved in recently and finds it to be A comfortable place with a pleasant atmosphere. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 There must be a complete, clear and accurate list of currently prescribed medication (including external preparations) for each person and of the time and date of administration. This is to help ensure medication is safely administered as prescribed. 28/12/2009 2 9 13 Medication must be administered as directed. Adequate stocks must be maintained without overstocking. 28/12/2009 This is to enable continuity of treatment. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 Pressure care support plans should include monitoring of fluids and nutrition for each person so that all areas of risk
Page 8 of 10 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations are being identified, recorded and addressed in the persons care plan. 2 7 For people at risk, or who have pressure sores, the condition of pressure areas should be regularly monitored and records kept. This is to ensure that each persons care plan is up to date and they are getting all the support they need. People who have medical conditions, such as diabetes, should have health care plans written to meet their specific needs. This is to ensure they will receive the all the the care and treatment they need to keep them healthy. Staff need to keep clear records of contacts with health professionals and the outcomes. This is to ensure that peoples care plans will be updated accordingly and staff will have the guidance they need to support them properly and safely. Handwritten entries and alterations to medicines administration records should be checked and countersigned to reduce the risk of mistakes. The number of night staff on duty should be regularly reviewed by management, in accordance with the needs of people who live in the home. This is to ensure there will be enough staff on duty to support people properly and safely. 3 8 4 8 5 9 6 27 Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - 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!
