Inspection on 26/05/05 for Thornton Hill

This inspection was carried out on 26th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Thornton Hill 31/07/07

Thornton Hill 15/08/06

Thornton Hill 15/09/05

Thornton Hill 09/02/05

Thornton Hill 17/09/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Thornton Hill Church Road Thornton in Craven Skipton BD23 3TR Lead Inspector Irene Ward Unannounced 26 May 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 J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 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 Post vacant Care home only 64 Category(ies) of OP Old age registration, with number of places Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9th February 2005 Brief Description of the Service: Thornton Hill provides personal care and accomodation for up to 64 older people who do not have any speacilist 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 J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This relates to an unannounced inspection carried out on 26th May 2005, which started at 9.00 hrs and finished at 16.00hrs. A tour of the home was not carried out on this occasion. A selection of records were 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 five service users in detail to establish if they corresponded with service users experiences in the home. There were discussions with Pearl Millin who is the registered manager from another one of the Anchors Homes and is the temporary manager for Thornton Hill and had only worked in the home for three days. Penny Fletcher temporary area manager was also available and was present throughout the discussions. Anchor Trust took over the management of the home in August 2004. There have been four managers since then. This may have also contributed to the number of concerns identified during this inspection such as care practises, staff attitude, and the institutionalised culture within the home which all need to be addressed. A strong management team for this home had been discussed at previous inspections and continuity in management is needed to improve the quality of life for the service users living at Thornton Hill. What the service does well: What has improved since the last inspection? Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 Page 6 A new monitored dosage system for medication has been introduced, which has been inspected by the pharmacist who has also carried out a training session with staff. This should ensure that service users receive medication safely. New care plans (Individual Life Style Agreements) have been introduced. However work still needs to be done, so that all the needs of service users can be met. 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 J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 Comprehensive assessments are not always being undertaken, which means service users needs are not being identified and met. EVIDENCE: Assessments have not been carried out to ensure that staff can meet the needs of the service users living at the home. Documentation in service users files contained the Individual Lifestyle Agreements although there was no evidence of any pre- assessments carried out prior to service users admission into the home. Throughout the day it was clear that a number of service users need to be re-assessed to ensure that the quality of life for some service users is not jeopardised in any way. The home does not provide intermediate care for service users. Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 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) 7,8,9 and10 The health care needs of service users are not fully met. EVIDENCE: Individual Lifestyle Agreements have been completed, however five case files inspected showed these to be incomplete with little information regarding meeting the needs of individual service users. Lifestyle agreements must be comprehensive in detail and reviewed and updated regularly. This has not been the case, as they did not reflect an accurate picture of peoples needs. In discussions, observation and in some documentation, evidence suggests that there are a number of service users with high dependency needs that are not reflected in all the service users lifestyle agreements. It was agreed for the temporary manager to arrange thorough assessments to be carried out as soon as it is possible. In discussion held with two service users who were there on respite care about staff respecting their right to privacy, the subject of bathing was raised. One service user said that although she bathed at home and did not need assistance “I have been told that I need assistance with bathing here, by staff, I don’t need it when I am home, I suppose they are frightened that I may fall” This was discussed with both the temporary manager and the area manager Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 Page 10 and was agreed to be looked into. This institutionalised approach to practice does not promote and respect service users rights to independence. Two service users had a dentist appointment and were assisted to attend the appointment with the help of staff. A new monitored dosage system for medication has been recently introduced to ensure that service users medication is stored securely and dispensed safely to service users. Medication records inspected were accurately maintained. Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 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) 15 While the food is of a good quality service users are not appropriately supported to ensure their dietary needs are met. EVIDENCE: Service users spoken with commented that the food at the home was very good and that there were always choices at each mealtime. Lunch was plated out for service users, and service users were not asked as to what they wanted to eat. However one service user who was confused was observed taking pastry off the pie and putting it on her serviette and kept saying it was hard. No staff member came to assist this lady. During lunch, observations were made that the staff that were giving out lunches were wearing plastic aprons and disposable gloves. This institutionalised approach to practice is not acceptable. This was reported back to the homes management who had asked staff in the past, to stop this practice. Management needs to closely monitor this and ensure the approach is changed. It was also observed that no staff member during lunch either asked service users if they required any assistance or assisted service users as necessary on the basis of their own observations. Staff had to be asked to assist another service user during lunch as she had become agitated. Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 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) None None of these standards were assessed. EVIDENCE: Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 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) 26 The standard of the environment has improved and provides service users with comfortable surroundings. 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. Not all the premises were inspected on this occasion including service users own private space. The dinning room in the main house had an offensive odour and requires attention. The conservatory was clean and free of any odours. Corridors running between the manager’s office and the main hall were clean well ventilated and free from any odour. One dinning room was closed due to a faulty dishwasher and a problem with the drain. This was being dealt with. Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 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) 29 Service users are protected by the homes 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. Staff are also given contracts of employment. There were 5 care staff, deputy manager and temporary manager on duty at the time of inspection. The area manager was also present throughout the day. Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 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) 31,33,36 and 38 Service users’ health, safety and welfare is not promoted and protected. EVIDENCE: Thornton Hill does not have a registered manager. Since the take over in August 2004 there have been a total of four acting managers. This does not give the home the stability that is needed for both service users and the staff. Although the home has held regular meetings with relatives and a consultation group for service users is to be set up regarding food provision. Throughout the day from discussions held with service users, staff and through observation, Thornton Hill currently fails to meet the needs of service users currently living there. Lack of thorough assessments of service users needs and Lifestyle Agreements not comprehensive in detail, as to what service users needs are and how they are met. Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 Page 16 One staff member was curt when spoken with and although an apology was given by the staff member concerned this, and the observations made when lunch was being served indicated that the attitude of some staff and the lack of care and respect shown to service users, needs to be urgently addressed. This is not the situation in other Anchor homes in this area and urgent action needs to be taken by the registered person(s) to address these problems. The failure to appoint a permanent manager has meant staff have not had appropriate supervision and leadership to demonstrate the organisations values within this home. There has been an ongoing investigation by the police relating to the death of a service user which may have resulted through the problems the home was having with the heating. This matter is now with the Coroner’s office. The issues regarding the heating have been addressed by the home. A number of Health and Safety records were inspected all of which were up to date and accurately maintained. Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 Page 17 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 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION x x x x x x x 1 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 1 x 1 x x 1 x 2 Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 Page 18 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP3 OP7 Regulation 14(1) (a)(b) (c) (d) 15(1) Requirement Assessments must be carried out to determine if the home can meet the needs of service users. Individual Lifestyle Agreements (care plans) must be sufficiently detailed to ensure that service users needs are fully met. Health care needs of service users must be reveiwed and documented. Service users must be treated in a manner which respects their privacy and maintains their dignity at all times. The institutionalised approach to personal care practices adopted by the staff group within the home must be addressed by the Registered Person(s) as a matter of urgency. The registered person must ensure that the main dinning room is kept clean and free of any offensive odours. The registered person must employ a registered manager. The registered person must ensure that all persons working at the home are appropriately supervised. The registered person shall make Timescale for action 31st August 2005 31st August 2005 31st August 2005 From the date of this report 3. 4. OP8 OP10 15(2)(b) 12(2)(4) (a) 5. OP26 23(2) (d) 31st August 2005 31st August 2005 31st August 2005 31st August Page 19 6. 7. OP31 OP36 8 18(2) 8. OP38 13 Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 suitable arrangements to ensure that service users are not at risk from falling out of a low level window situated in bedroom 47 on Manor Wing. 2005 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 OP14 Good Practice Recommendations The home reviews their present financial systems so that service users personal monies are held in the home enabling service users to have immediate access to monies for personal and recreational use. Mealtimes should be less institutonal and more of a social experirence for service users. Individual attention should be given to service users who require assistance. The home should work towards having 50 of care staff trained to NVQ level 2 or equivelant by 2005. 2. 3. OP15 OP28 Thornton Hill J53-J04 S60215 Thornton Hill V226756 260505 Stage 4.doc Version 1.30 Page 20 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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