CARE HOMES FOR OLDER PEOPLE
Thornton Hill Church Road Thornton in Craven Skipton BD23 7TR Lead Inspector
Irene Ward Unannounced 15 September 2005 09:00 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. Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Thornton Hill Address Church Road Thornton In Craven Skipton North Yorkshire BD23 3TR 01282 842023 01282 843959 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) Anchor Trust Application to be submitted Care Home only 64 Category(ies) of OP Old age registration, with number of places Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: NONE Date of last inspection 26 May 2005 Brief Description of the Service: Thornton Hill provides personal care and accomodation for up to 64 older people who do not have any specialist requirements and is owned by Anchor Trust. The home is a large converted manor house with a purpose built extension known as the Manor Wing. The accomodation is spaced over two floors. The upper floors are acccessible by a vertical lift. The home is set in its own grounds overlooking a valley. Thornton Hill is situated in the village of Thornton-in-Craven approximately 8 miles from Skipton. Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This relates to an unannounced inspection carried out on 15 September 2005, which started at 9.00 hrs and finished at 15.30 hrs. A tour of the home was carried out on this occasion. A selection of records was looked at and time was spent observing activity in the home, talking and listening to service users, relatives and staff. The focus of the inspection was a number of key standards, inspecting the care records of four service users in detail to establish if they corresponded with service users experiences in the home. There were discussions with the new manager Andrea Smith. Who has only been in post for a matter of weeks and is the fifth manager since Anchor Trust took over the management of the home in August 2004. Her application as the registered manager has not yet been received for processing. Significant changes have been made to improve the quality of life for service users living at the home, which was confirmed by service users and through observations made on the day. Progress is also being made to improve the environment of the home. Major building works is being carried out mainly to the entrance of the home. Other areas of the home are also being refurbished. What the service does well:
Food was good with plenty of choice. Service users were complimentary towards the catering service. The standard of the environment continues to improve, with attention being given to the safety of service users. However there are significant changes that need to be made to improve the quality of service provision. The organisation’s recruitment procedures are adhered to, which ensures that service users are protected at all times. Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 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 Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 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 and 6 Prospective service users have good opportunities to ensure their needs can be met by the home before deciding to live there. EVIDENCE: Assessments are now carried out prior to any admissions into the home. All service users living at the home have had their care needs re-assessed to ensure that the home is able to meet service users’ needs. Service users files contained their care plan (Individual Lifestyle Agreements that have been completed and agreed and signed by service users. Files also contained assessments and initial care plans from funding authorities where applicable. The home continues not to provide intermediate care. Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 9 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 and 10 The health care needs of service users are generally well met. EVIDENCE: Each of the four case files inspected, including the most recent service user admitted, contained an informative and detailed care plan (Lifestyle Agreement). Risk assessments have been carried out and covered a number of aspects of daily living. Service users’ care plans have been reviewed. Records of allergies had not been completed and the manager agreed that these would be done. During a conversation with a service user, at lunchtime, it was clear that he had some discomfort with his dentures and could not eat his dinner, although he was able to eat his sweet. This was discussed with the cook who was not aware that the service user was having problems eating. It was agreed that provision would be made for soft food to be provided, until the service user is able to resume eating again. This was discussed with the manager who stated that she or any of the care staff were not aware of the situation and action would be taken immediately to see if the service user was suffering with an infection. It was also noted that the service user had a watch on his wrist that
Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 10 was showing the wrong time. This service user has the onset of dementia and in discussions with the manager it was agreed that staff must be reminded that when they are supporting service users they must also give attention to detail in areas such as making sure someone’s watch is set at the right time. This is paramount when respecting and promoting service users’ dignity. Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 11 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 and15 Service users’ lifestyles within the home reflect their wishes. EVIDENCE: Service users spoken with commented that the food at the home was very good and that there were always choices at each mealtime. During lunch, observations were made that the staff were helpful and supportive of service users and assisting where necessary. In discussions held with service users individually and as a group service users confirmed that improvements had been made to food provision since the last inspection. Social activities such as bingo and quizzes are ongoing although one service user who was asked about activities in the home said that they were “null and void.” The manger confirmed that an activities co-ordinator for 20hrs. a week had been employed and was to commence in the next week. Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 12 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 and 18 Service users are confident that their complaints and concerns are dealt with and are acted upon. EVIDENCE: The home’s complaints procedure is available to service users and visitors as it is on display in the main entrance to the home. Service users confirmed that when they have had a complaint it has been acted upon. The manager is aware of the procedures to follow when a service user discloses any form of abuse. Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 13 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 and 26 The standard of the environment continues to be improved and provides service users with a clean and comfortable place in which to live. EVIDENCE: The home is a large converted manor house with a large entrance hall. There are several lounges and dinning rooms. There is a vertical lift to the upper floors. All the communal areas were clean and free of any odours. Service users rooms have been personalised and were also clean and well maintained. Improvements have been made and continue to be made, as the home goes through major programmes of refurbishments. Improvements have been made to the cleanliness of the home through commitment from the housekeeping staff to maintain a clean home for service users. Even through the difficulties they encounter with the ongoing building works being carried out. Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 14 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) 27,29 and 30 Service users are protected by the home’s recruitment procedure. EVIDENCE: Two staff files were inspected. One person who had recently commenced working at the home had all the relevant checks undertaken prior to commencing work at the home. Both staff files inspected held completed application form and health questionnaire. CRB checks have been carried out and staff have been checked against the POVA first list. All staff are given contracts of employment. The staff rota showed that there are four care staff and a senior on duty each shift. This does not also include the manager. At night there are two care staff and a senior on duty each night. There is a separate rota for all the ancillary staff. Staff training is ongoing and the manager intends to ensure that all staff completes induction training in line with TOPSS, to ensure a consistent approach to care practices within the home. Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 15 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) 35 and 38 Service users’ health, safety and welfare are not fully met. EVIDENCE: A number of health and safety records were inspected all of which were up to date and accurately maintained. During the tour of the home a number of fire doors were wedged open. The manager removed these immediately. In discussions that followed it was agreed that the manager is required to make sure that these fire doors are not wedged open at anytime. The home is in the process of installing automatic door closures to alleviate this problem. Three service users’ personal allowances were inspected, which were all accurately maintained. Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 16 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 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x 3 x x 1 Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 17 NONE 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. 2. Standard OP10 OP38 Regulation 12 23(4) Requirement The registered person must ensure that service users health care needs are met. The registered person must ensure that fire doors are not wedged open. Timescale for action From the date of the inspection From the date of the inspection. 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 OP 10 Good Practice Recommendations Staff should as a matter of good practice ensure that service users dignity is also maintained and promoted at all times. Thornton Hill 20050909 Thornton Hill X00015 UN Stage 4 S60215 V248902 J53.doc Version 1.40 Page 18 Commission for Social Care Inspection Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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