CARE HOMES FOR OLDER PEOPLE
Thornton House Thornton House Teal Close Off Mayfield Avenue Thornton Cleveleys Blackpool FY5 2LS Lead Inspector
Christopher Bond Unannounced Inspection 17th October 2005 10:00 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 House DS0000033224.V260859.R01.S.doc Version 5.0 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 House DS0000033224.V260859.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Thornton House Address Thornton House Teal Close Off Mayfield Avenue Thornton Cleveleys Blackpool FY5 2LS 01253 825845 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) Lancashire County Care Services Mrs Sheelagh Francis Chippendale Care Home 35 Category(ies) of Dementia (21), Mental disorder, excluding registration, with number learning disability or dementia (1), Old age, not of places falling within any other category (12), Physical disability (10) Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Staffing to be provided to meet the assessed needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is to be registered for a maximum of 44 service users to include: Up to 1 named person in the category of Mental Disorder (female) (MD) (1) Up to 21 service users in the category of Dementia (DE) (21). Up to 10 service users in the category of Physical Disabilities (PD) (10). Up to 12 service users in the category of Older People (OP) (12). 1st February 2005 2. 3. Date of last inspection Brief Description of the Service: Thornton House is a large care home situated in Thornton-Cleveleys near Blackpool, Lancashire. The home is registered for up to 44 service users. This includes a number of service users with Dementia. After an extensive refurbishment in the summer of 2004 the home now has 44 single rooms and several of these are en-suite. A Day-Care centre had also been added and the rehabilitation unit had also been upgraded. The home is situated in a residential area fairly close to transport routes and shops. Thornton village is a short walk away where several shops and resources were situated. Garden areas within the home have also been refurbished and there are areas where service users can sit outside when the weather is good. The home has a through floor lift. Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over three hours. Care staff and residents records were looked at and the manager gave the inspector a tour of the home. Residents and care staff were spoken to as part of the inspection. Several comment cards were received from relatives as part of the inspection process. What the service does well: What has improved since the last inspection?
More than 50 of care staff are now trained to a recognised care qualification. This means that care staff have the information to help them do their jobs better. Specialist staff training has taken place in Dementia Awareness and the care staff are supplied with recent information about the condition. This has helped to improve care within the home. A new sprinkler system has been installed to help improve fire safety in the building.
Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 Page 6 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 DS0000033224.V260859.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 3, 4 and 6 Thorough admittance procedures and careful assessment ensures that the home can meet people’s needs. Written information provided to prospective residents is good enabling an informed decision about admission to the home to be made. EVIDENCE: The manager of the home provided plenty of information about the service to those who may want to live there. This information included the facilities that the home offered and the category of resident that the home was registered for. It was clear that the manager was carrying out detailed needs assessments prior to new residents being admitted. This would clearly help when planning what care the resident would need within the home. The manager confirmed that good assessment was a priority to ensure that the home would be able to care for the residents successfully.
Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 Page 9 All of the residents within the home had detailed contracts to tell them what service the home would offer them and what their entitlements were. There were several residents who were in the rehabilitation unit of the home. It was clear that there was a structured programme of rehabilitation, which helped to ensure that people returned to their own home should they be assessed as able to do so. There were multi-disciplinary meetings held regularly to discuss and make decisions regarding those residents in the rehabilitation unit. Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 7, 8, 9, and 10 Promotion of health is taken seriously. Resident’s welfare is closely monitored and health needs were met. Residents are treated with dignity and respect. EVIDENCE: Individual records were kept for each resident with a plan of care setting out in detail the action that needed to be taken by care staff to ensure all aspects of health, personal and social care needs of the residents were met. Each plan of care was reviewed on a monthly basis. Many of the residents at Thornton House had Dementia. There was a detailed programme of care to ensure that these residents were cared for correctly. Many of the care staff and managers had undertaken a distance- learning course in Dementia care to ensure that they had the knowledge and skills to care for residents properly and successfully. There were one or two residents who had pressure sores. The district nurse came to the home daily to help to care for these residents. The home had what is termed as a ‘Primary Nurse’. This helped to ensure that the same nurse
Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 Page 11 came every time. This meant that communication between the home and the nurse was better and continuity for the residents was improved. There were no concerns about medication procedures within the home. Many of the care staff had undertaken training in this area and the correct policies and procedures were available to help ensure that residents were not put at risk. Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 12, 13 and 14. Social activities were well -managed, creative and provided daily variation and interest for the people living in the home. Family and friends were encouraged to visit therefore ensuring personal relationships are maintained. EVIDENCE: There were specialist activities especially for those residents that had dementia. This was very important as it helped to ensure that the residents were being cared for according to their needs. Other residents enjoyed activities such as bingo and dominoes, and entertainers were invited into the home on a regular basis. There were several visitors to the home during the inspection. It was clear that residents were given privacy with their visitors. One relative wrote via a comment card, “The home look after my mum and dad very well and I am always made to feel very welcome when I visit”. There were regular residents meetings where people could be involved in making decisions that affected their lives.
Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 Arrangements for complaints are handled well and taken seriously ensuring people feel listened to. People are protected from harm but this needs to be reinforced by the employing agency through training. EVIDENCE: There was lots of information around to help those who wished to voice their concerns. The complaints procedure was posted in the hallway and there was also information in the Service User Guide and Statement of Purpose for the home. Residents could also voice their concerns informally with the manager and staff or at residents meetings. The management team helped to ensure that all care staff were given information about the forms and recognition of abuse. Each support worker is told of this during his or her induction and supervision. It is important the employing organisation back this up with regular planned training to help ensure that service users are not put at risk. Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 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 the following standard(s): This section was not assessed during this inspection. EVIDENCE: Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30. Robust recruitment and selection practices are consistently carried out by the employing organisation, ensuring that clients are protected. Training is considered a priority so that a competent and well- trained staff team assists service users. EVIDENCE: There were no concerns regarding the amount of care staff that were on duty within the home. Care staff files showed that recruitment was being carried out correctly and that information on each support worker was up to date and accurate. Checks were carried out before employment to ensure that support workers were free from criminal convictions. This helped to ensure that service users were safe. The manager confirmed that care staff received regular 1-1 supervision with their manager to discuss self -development and training issues. Both the manager and assistant manager were well trained to do their jobs and the home had reached its target of having over 50 of care workers with the mandatory National Vocational Qualification level 2 or 3 award. There was some very good training available for care staff regarding ‘positive dementia care’. The home had a good induction procedure and there had been
Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 Page 16 training completed in a number of important areas. This helped to ensure that care staff had the right information to do their jobs properly and that residents were safer and not put at risk. Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This section was not assessed during this inspection. EVIDENCE: Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 Page 19 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 OP18 Regulation 13, (6) (7) and (8) Requirement The registered person must provide regular training regarding abuse awareness. Timescale for action 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Thornton House DS0000033224.V260859.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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