Inspection on 31/07/07 for Thornton Hill

This inspection was carried out on 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Thornton Hill 15/08/06

Thornton Hill 15/09/05

Thornton Hill 26/05/05

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 North Yorkshire BD23 3TR Lead Inspector Hebrew Rawlins Key Unannounced Inspection 31st July 2007 09:00 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 Thornton Hill DS0000060215.V345325.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. Thornton Hill DS0000060215.V345325.R01.S.doc Version 5.2 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 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) www.anchor.org.uk Anchor Trust vacant post Care Home 52 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (45) of places Thornton Hill DS0000060215.V345325.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2006 Brief Description of the Service: Thornton Hill provides personal care and accommodation for up to 64 older people. It is owned and operated by Anchor Trust. The home is a large converted manor house with a purpose built extension known as the Manor Wing. The residents are located on the ground and first floors only and there is a vertical lift to provide level access to the first floor. 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. The weekly fees range from £425 to £600. This information was received by the Commission For Social Care Inspection on the 4th July 2007. People who use the service/relatives and other interested parties are able to have access inspection reports as they are displayed in the reception area of the home. Thornton Hill DS0000060215.V345325.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. Information about the inspection process can be found on our website www.csci.org.uk This site visit was unannounced and carried out by one inspector who was at the home from 09.00 until 16.30 on 31st July 2007. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who use the service and in accordance with requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the inspection visit. During the visit a number of documents were looked at and all areas of the home used by the people living there were visited. A good proportion of time was spent talking with the people who live at the home as well as with the acting manager and staff. The acting manager had completed an Annual Quality Assurance Assessment (AQAA) before the visit to provide additional information about the home. Survey forms were sent out before the visit to the people who use the service, relatives, carers, general practitioners (GPs) and other healthcare professionals. Several were returned and information provided in this way will be reflected in the report. Feedback at the end of this inspection was given to the acting manager. Thanks are extended to everyone who contributed to the inspection and for the hospitality during the visit. What the service does well: Thornton Hill provides comfortable accommodation in a relaxed, welcoming and homely environment. There is a good rapport between staff, people in the home and their relatives. Thornton Hill DS0000060215.V345325.R01.S.doc Version 5.2 Page 6 The home recognises the importance of welcoming visitors, and makes sure people feel comfortable and are offered refreshments. Staff are good at respecting the privacy of people. During the inspection people said staff always knocked on bedrooms door before entering. People who use the service confirmed that they could see visitors at anytime helping them keep in contact with family and friends. Comments from relatives and visitors were all positive. Relatives made comments such as “this is a good home, it is kept very clean and there are never any odours and the staff are very helpful”. “We feel that we made a very wise choice of home”. What has improved since the last inspection? What they could do better: Staff need more help and support with implementing the new organisational care plans. They must be able to work with a care plan that gives clear and precise instructions on how to deliver care in a way that meets individual needs and choices. Without this in place there is no guarantee that all the needs of the people will be met. Care records must be reviewed and always be kept up to date otherwise there is the possibility that some care may not always be delivered according to the wishes and needs of the person. The home must make sure all forms relating to the health/well being of people living in the home are completed fully. Without these in place there is no guarantee that all the needs of the people will be met. Medication practices must always be delivered/followed according to the home’s policy; otherwise people who use the service are potentially at risk. The manager needs to make sure staff training records are kept up-to–date at all times. This will show that the management recognise the benefits of a skilled, trained workforce. Thornton Hill DS0000060215.V345325.R01.S.doc Version 5.2 Page 7 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. Thornton Hill DS0000060215.V345325.R01.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 Thornton Hill DS0000060215.V345325.R01.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): 1, 2, 3, 4 and 5. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are able to visit the home and have access to written information so that they can make an informed choice about moving in. The home’s new pre-admission assessment information provides detailed information about the precise needs of people in all aspects of their care. However they were not always completed fully, so some care needs may be overlooked. EVIDENCE: Relatives spoken with on the visit said they were given written information about the home and the facilities Thornton Hill provided. The acting manager said the service users guide is being reviewed. Thornton Hill DS0000060215.V345325.R01.S.doc Version 5.2 Page 10 One person said during her mothers pre-admission assessment she thought the staff were very ‘helpful’ and reassuring. The acting manager said all the people living in the home or their representatives have been issued with written contracts. In the care plans looked at all had a signed contract showing the terms and conditions of occupancy. There were assessment details in the records sampled, however the home’s pre-admission assessment did not provide sufficient information about the person’s needs and strengths in all aspects of their care and in some case not enough information to form the basis of a care plan. People feel the care home usually meets their needs. In a survey returned one comment said “physical needs seem to be catered for but spiritual needs not really considered”. Thornton Hill DS0000060215.V345325.R01.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 and 11. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are aware of the specific needs of people using the service, but because these are not always recorded, there is the possibility that some care may not always be delivered according to the wishes and needs of the person. People’s health care needs are met, however medication practices are not always delivered according to the home’s policy placing people at potential risk. EVIDENCE: The controlled medication forms did not always have the signature of two staff members. Medication administration sheets were not always completed for each person. The records should show when people refuse their medication and why. If this persists the GP should be informed otherwise people’s health could be at risk. Thornton Hill DS0000060215.V345325.R01.S.doc Version 5.2 Page 12 In the files looked at there was no evidence that the people living in the home agreed with the home’s policy on medication. The medication administration agreements were not signed. A lot of information in people’s care file was not completely filled in for example life history, why night checks were agreed, accidents records, daily fluid balance chart, and monthly reviews. Because records were not kept up to date it suggested that a person had not had a bath for three weeks, which the acting manager said, was not the case. There is a request list on people’s files in the event of death this was also not filled in so there was no evidence to show the home could meet the wishes of people. There was no evidence to show that people using the service or their relatives are involved in the care plans. Throughout the inspection staff respected the privacy of people living at the home and always knocked before entering bedrooms. From discussions with people living at the home and from the returned completed survey forms it is clear that they feel that their dignity and privacy are respected There was evidence in records that people have access to GPs (General Practitioner), chiropodody, dental and optical services. A relative spoken with said, “I have been informed via the telephone and on visits of any accidents”. Another said “there are varying degrees of disability amongst the residents and residents are both male and female. The home meets the needs of these people as far as I am aware”. Thornton Hill DS0000060215.V345325.R01.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): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The level of activities provided on a day-to-day is good for the people living in the home. Visitors are made to feel welcome. A good and varied diet is provided. EVIDENCE: Staff described the level of choice available to people and were knowledgeable about the importance of people retaining as much independence as possible. Throughout the inspection staff were seen to respond to the individual choices of people. The home employs an activities co-ordinator and a list of activities is on the wall planner in the dining room. On the day of the visit people were seen taking part in quiz games. People are able to spend their day how they choose. One person said he prefers to spend time in his room listening to music, watching television and staff go in to chat when they can. Thornton Hill DS0000060215.V345325.R01.S.doc Version 5.2 Page 14 A person spoken to on the visit said “ there are plenty of activities available to me but I cannot always join in on some due to my medical condition.” Comments made by a relative in the survey returned said “encouragement and support should be given to allow them to walk outside and even go down into the village”. Visitors are made very welcome and offered refreshments and privacy for their visit. Visitors spoken with on the day of the visit said that they were always made welcome and the staff looked after their relative very well. In a survey returned a relative said, “They try to promote the concept that this is the resident’s home”. For example, when my wife and I visited one day mum asked us to stay for lunch. Initially we declined until one of the carers said. If you’d like to stay for lunch you’re quite welcome. This is your mum’s home and she would like you to have lunch with her”. The menu showed that there is plenty of choice and variety. One relative said “there is a choice of food at mealtimes prepared and presented well”. Another described the food as being ‘excellent’. All people spoken to living in the home said the food was very good; they get up when they wish and visitors are able to visit at anytime. Thornton Hill DS0000060215.V345325.R01.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 and 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a robust complaints procedure and people are confident that complaints will be taken seriously. The staff team are aware of what to do if abuse is suspected or reported. EVIDENCE: The complaints procedure is displayed in the home, and during a conversation with two relatives both said that information on how to make a complaint was included in the introductory welcome pack given to people on admission. Returned survey forms showed that people know how to make a complaint. The home has a comprehensive policy and procedure on the action staff should take if abuse is suspected or reported. When asked, staff were clear about the different types of abuse. They were also confident about the reporting methods. No complaints have been made to the Commission for Social Care Inspection. People spoken to were confident that they could talk to the management about any concerns they had and that they would be taken seriously. Thornton Hill DS0000060215.V345325.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): 19, 20, 21, 23, 24, 25 and 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is clean and tidy throughout and offers a safe environment in which the people are able to live in comfort. EVIDENCE: The home has recently undergone a total refurbishment. The good quality facilities include a conservatory, dining room, training room and medical room. The dementia unit has been redecorated in an appropriate colour scheme to enhance the environment for people with dementia. It is designed with small areas to promote independence and privacy. The home is very well maintained. Bedrooms have en-suite facilities and are spacious enough for people who use walking frames. Thornton Hill DS0000060215.V345325.R01.S.doc Version 5.2 Page 17 Staff described the measures they take to prevent the spread of infection in the home and during the inspection they wore protective clothing when assisting people with personal care. In returned survey cards from people living in the home, all said the home was clean and free from offensive odours. The new laundry facilities are well equipped to meet the needs of the people in the home. The kitchen was clean and tidy throughout and the cook said all equipment was in working order. Thornton Hill DS0000060215.V345325.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 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are protected by a robust recruitment procedure and staff receive training relevant to their job. EVIDENCE: The recruitment files of two members of staff, appointed since the last inspection, were sampled and found to contain all the necessary checks to make sure that the person was safe and suitable to work with vulnerable people. All new staff receive induction training that meets national guidelines. The home has a training file for staff. This identifies what training staff have completed and what training is needed, however not all the training files are kept up to date. Training needs are identified through supervision and appraisal. All catering staff have received training in safe food handling and 75 of the care staff. From information supplied in the Annual Quality Assurance Assessment 5 of the 23 care staff have achieved a National Vocational Qualification (NVQ) at level 2 or above and 5 staff are working toward NVQ or above. Thornton Hill DS0000060215.V345325.R01.S.doc Version 5.2 Page 19 Surveys returned said, “we feel that we made a very wise choice of home”. “Mum frequently says, “It’s like a home from home”. From my point of view the staff are welcoming and friendly and helpful”. “The atmosphere at the home is calm and relaxed”. Thornton Hill DS0000060215.V345325.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): 31, 32, 33, 34, 36, 37 and 38. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The interests of people in the home are very important to the management and staff. However there are some issues around care plans and medication record keeping which must be addressed to safeguard people all times. EVIDENCE: The registered manager is on maternity leave so the deputy manager is now the acting manager. Staff described her as someone who is always willing to help and support. The home is working with a new care plan system and it appears staff do not fully understand how it works. Hence, the shortfalls in the care records. Thornton Hill DS0000060215.V345325.R01.S.doc Version 5.2 Page 21 There is an established system in place for supervision of staff. The format used indicated that personal development; training and goal setting are amongst the topics covered. The manager must make sure staff training records are kept up-to–date at all times. This will show that the management recognise the benefits of a skilled and trained workforce. Quality assurance systems are in place with questionnaires being sent out to relatives on an annual basis. Staff and people living in the home meetings are held regularly. There are clear records of all peoples’ money and the home has clear policies and procedures about handling people’s monies. Information supplied with the Annual Quality Assurance Assessment shows that all servicing and maintenance of equipment takes place as necessary. Thornton Hill DS0000060215.V345325.R01.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 3 3 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 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 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 x 3 2 3 Thornton Hill DS0000060215.V345325.R01.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 OP3 Regulation 15 Requirement The home’s pre-admission assessment must provide sufficient information about the person’s needs and strengths in all aspects of their care to form the basis of a care plan. This will make sure that care needs are not overlooked. Care plans must specify the precise care needed to make sure that care is delivered according to individual needs. Medication practices must always be delivered/follow the home’s policy. Otherwise people who use the service are potentially at risk. The home must make sure all forms relating to people’s health/well being are completed fully. Without these in place there is no guarantee that all the needs of the people will be met. The manager needs to make sure staff training records are kept up-to–date at all times. This will show the management recognise the benefits of a skilled, trained workforce. DS0000060215.V345325.R01.S.doc Timescale for action 30/09/07 2 OP7 15 30/09/07 3 OP9 13 30/09/07 4 OP11 15 30/09/07 5 OP30 18 30/09/07 Thornton Hill Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Thornton Hill DS0000060215.V345325.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Thornton Hill DS0000060215.V345325.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!