CARE HOMES FOR OLDER PEOPLE
Thornton House 94 Chester Road Childer Thornton South Wirral CH66 1QL Lead Inspector
Gill Matthewson Announced 13 July 2005 9:30 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 House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Thornton House Address 94 Chester Road Childer Thronton South Wirral CH66 1QL 0151 339 0737 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) Mr Andrew Henry Blomfield Beryl Tidbury Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Thornton House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 180105 Brief Description of the Service: Thornton House is registered as a care home to provide a service to older people who may need assistance with a range of personal care tasks.The home is run as a private enterprise with the registered provider having an active participation in the daily management of the home. The home is located on the outskirts of Ellesmere Port in a small local community within reach of local services, community facilities and public transport.The facilities offered by the home include single bedroom accommodation, a separate dining room and three lounge areas, one of which is a conservatory extension to the building. There is a large and well-maintained garden to the rear of the property.The home is staffed 24 hours a day including two waking night staff. The staffing complement also includes kitchen and domestic staff.A stair lift is available to transfer residents between the ground and first floors. Thornton House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out by one regulatory inspector. The inspector spent two hours planning the inspection by reviewing previous inspection reports, the service history over the last twelve months and comment cards. Comments were received from eight residents, eleven relatives, one social worker, one physiotherapist, one NVQ trainer and three GPs. The inspection took place over six hours and included a tour of the building, inspection of records and discussion with seven residents, two relatives, the registered provider and registered manager, three staff and two community nurses. Feedback was given to the registered provider and registered manager immediately following the inspection. What the service does well:
All prospective residents’ needs are assessed prior to admission and the manager discusses with them or their relatives how the home will be able to meet their needs. The home provides a very high standard of care. Comments received from relatives included ‘ excellent all round care in every respect’ and ‘I am impressed by the level of care’. One GP commented ‘ I would be happy for a member of my family to live here’. Residents are treated with respect. A visitor commented that staff were ‘always courteous, friendly and helpful’. Residents are able to maintain autonomy and exercise personal choice in all aspects of their daily lives, including maintaining contact with friends and family. Meals are appetising and nutritious. One resident commented that the food was ‘outstanding’. Any complaints or concerns are dealt with promptly and effectively. The home is clean, well furnished and nicely decorated.
Thornton House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 6 Staffing levels and training ensure that residents’ needs can be met. Residents and visitors were particularly complimentary about the staff, saying they were ‘caring and helpful’ and ‘nothing is too much trouble’. A GP commented that the staff are ‘excellent’. 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 House F51 F01 S6545 Thornton House V230837 130705 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 House F51 F01 S6545 Thornton House V230837 130705 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 Residents assessed prior to admission to ensure that the home can meet their needs. EVIDENCE: The registered manager carried out pre admission assessments and where appropriate there were supporting assessments from health and social care professionals. It was normal practice for a representative from the home to visit the prospective resident in his or her own home or in their current health or social care setting prior to admission. Thornton House F51 F01 S6545 Thornton House V230837 130705 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) 7,8,9,10&11. Residents’ needs are set out in an individual plan of care to ensure that all their personal and health care needs are met. Residents receive their prescribed medications as directed by their doctor. Their privacy and dignity is maintained and care and comfort is given to those who are in their final days, in accordance with their wishes. EVIDENCE: Case tracking was carried out for two residents. This included talking with the residents, a relative, staff and a visiting health care professional. Their care and medication records were also examined. Care plans were drawn up to provide staff with details of what action they needed to take to ensure that the residents’ needs were met. These care plans were reviewed on a regular basis and updated as needs changed. They also contained signatures of residents and relatives, which indicated that they consulted throughout the care planning process. Thornton House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 10 Residents confirmed that staff assisted them to maintain their personal hygiene as necessary and visitors commented that residents always appeared clean and well groomed. Examination of care files evidenced that staff are clearly guided towards maintaining and promoting personal health as a significant aspect of the care offered. Residents were assessed as to their risk of developing pressure sores and appropriate pressure relieving equipment was provided. Residents were referred to a continence adviser if necessary and appropriate aids were obtained. Adequate arrangements were in place for residents to obtain hearing and sight tests and access to health care professionals as required. Care files contained evidence of referrals to physiotherapist, dietician, GPs, district nurses. Medication administration records were completed in accordance with regulations and demonstrated that residents received their prescribed medication. Residents confirmed that staff treated them with respect and maintained their dignity when attending to personal care needs. Residents had access to a telephone in a quiet area of the home and received their mail unopened. Residents also had a telephone in their own room. Staff used a formal term of address, such as Mrs Smith or Mr Jones, unless the resident requested otherwise. Care files contained evidence that residents’ wishes concerning terminal care and arrangements after death were discussed. Residents were able to spend their final days in their own rooms, surrounded with their personal belongings. Discussion with staff confirmed that they are able to spend time with and offer comfort to those residents. Appropriate assistance and advice was sought from the community health care team. A nurse from the local palliative care team confirmed that the staff provided a good standard of care and always followed their advice and instructions. Thornton House F51 F01 S6545 Thornton House V230837 130705 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) 12,13,14&15 Residents are able to maintain contact with friends and loved ones and the home is conducted so as to maximise residents’ choice and control over their lives. Meals are varied, appealing and nutritious. However, the programme of activities is not extensive enough to ensure that all residents’ social and recreational needs are met. EVIDENCE: Discussion with residents confirmed that most were satisfied with the range of activities available. These included visits from a mobile library, visiting singers every other month, a visiting hairdresser, trips out to the local garden centre and occasionally to the theatre. Board games and jigsaws were also available. Most residents spoken with said that they were happy to watch the television and read or play a game of Scrabble with the staff, but some said that there used to be a better range of activities on offer and they would like more to do. The manager said that the home employed an activity coordinator but she had been on leave for some time. The registered provider agreed that it was something he needed to address. See Recommendation 1. Thornton House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 12 Residents and visitors confirmed that they were able to maintain contact and that there were no restrictions on visiting. One resident said she went out regularly with her daughter, and another went out to a church service on the morning of the inspection. The manager said that another resident likes to go shopping and they drop her off and pick her up after a couple of hours. Residents were able to bring personal possessions into the home with them, and most bedrooms were well personalised with small items of furniture, pictures, photographs and ornaments. The notice board displayed details of an advocacy service provided by Age Concern, who would act in residents’ interests if required. Menus demonstrated that residents are offered one of two choices at every mealtime, apart from Sunday lunch, which is always a roast dinner. Residents said that the meals were excellent and two residents said that when they hadn’t been well they were able to ask for more or less anything they wanted and it was provided. Tables were set attractively for lunch and staff were observed serving and assisting residents, both in the dining room and in residents’ bedrooms. They paid attention to detail to ensure that the food looked appealing and was served in a way that enabled the resident to eat independently if possible, for example peeling and cutting fruit. Thornton House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 13 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 Residents have access to a clear complaints procedure and complaints are dealt with promptly and effectively. EVIDENCE: The home has a satisfactory complaints procedure that is displayed on the notice board and in the service user guide. Residents confirmed that they would know how to complain. Records are maintained of any complaints received, investigations and any action taken. The home had received two minor complaints in the previous year, both having been quickly resolved. Thornton House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 14 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&26 In the main, the home provided a clean and pleasant environment for residents to live in. EVIDENCE: The home was well furnished and maintained in good decorative order, with the exception of some plaster damage that had been caused to the wall of one bathroom by the handle of the bath hoist. See Requirement 1. The home was spotlessly clean with the exception of one rubber bath mat that had some mould on the underside. The registered provider said it would be replaced immediately. One first floor bedroom window did not have a restrictor fitted and could be opened wide. This window was only a few inches from floor level and could pose a risk of falling out if the resident leaned over to grip the handle to close it. See Requirement 2. Thornton House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 15 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) 27,28&30. Residents’ needs are met by sufficient numbers of suitably trained staff. EVIDENCE: There were twenty people resident at the time of the inspection. The home provided four care staff on duty from 8am to 1pm, three or four from 1pm to 6pm, and two from 6pm to 8am. These numbers were sufficient to meet residents’ needs. The manager was supernumerary. The home also employed domestic and catering staff. Records demonstrated that all staff received an induction to the home that covered the Skills for Care induction targets. New staff were supernumerary for approximately one month. Forty seven percent had achieved an NVQ Level 2 in Care and three more were working towards it. Staff had also undertaken training in dementia care and ten staff had a certificate in administration of medication. Thornton House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 16 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) 38 Residents’ health and safety are promoted and protected so far as is reasonably practicable. EVIDENCE: All staff received training in fire safety, moving and handling, food hygiene and infection control on induction and received regular updates. Those staff who had obtained an NVQ Level 2 in Care also had certificates in first aid. Fire safety systems were tested and serviced at the required intervals. The home had received a fire safety inspection in December 2004 and a plan was in place to replace smoke seals to doors identified by the fire officer. Other requirements had been addressed. All residents were assessed in relation to their moving and handling needs on admission and reviewed regularly. The home provided two portable mini hoists and two baths with hoists. Bath taps were fitted with thermostatic mixer valves to reduce the risk of scalding.
Thornton House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 17 The registered provider was an accredited fire trainer and had also attended training on the testing of portable electrical appliances. Both he and the registered manager were due to attend training in being a moving and handling facilitator in July. Service contracts were in place for the routine servicing and maintenance of equipment. Accident records were maintained in accordance with requirements. Accidents over the previous three months were reviewed and gave no cause for concern. Thornton House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 18 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x 3 Thornton House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 19 No 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 OP19 OP19 Regulation 23(d) 13(4) Requirement The registered person must make good the plaster damage to the bathroom wall identified. The registered person must fit a window restrictor to the first floor bedroom window identified. Timescale for action 13.08.05 27.07.05 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 OP12 Good Practice Recommendations The registered person should expand the programme of activities, taking into account the recreational needs of the residents. Thornton House F51 F01 S6545 Thornton House V230837 130705 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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