CARE HOMES FOR OLDER PEOPLE
Thornton Leigh Care Home 42 Huyton Lane Huyton Knowsley Merseyside L36 7XG Lead Inspector
Mrs Joanne Revie Unannounced Inspection 10:00 2 December 2005
nd 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 Leigh Care Home DS0000021485.V270940.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 Leigh Care Home DS0000021485.V270940.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Thornton Leigh Care Home Address 42 Huyton Lane Huyton Knowsley Merseyside L36 7XG 0151-489-1950 0151 480 9703 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) Mr Ronald William Baker Mrs Valerie Elizabeth Baker Mr Ronald William Baker Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15), Physical disability over 65 years of age of places (15) Thornton Leigh Care Home DS0000021485.V270940.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 15 OP and up to 15 PD(E) Date of last inspection 21/03/05 Brief Description of the Service: Thornton Leigh is owned and managed by Mr and Mrs Baker. Both are retired nurse tutors who also hold a recognised nursing qualification. The home is an older property, which has been well maintained and has many original features. This helps to promote a comfortable and homely atmosphere. Thornton Leigh benefits from an established garden, which is readily accessible to residents. The home is situated on a main road within walking distance of the shopping facilities of Huyton Village. The home is managed around the Christian Ethos. Prayer meetings are held twice weekly and daily readings from the bible are read at lunchtime for those residents who follow a Christian faith and wish to be involved. Residents who are non Christians are also welcome at the home. Thornton Leigh Care Home DS0000021485.V270940.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The visit was unannounced. Discussions were held with three residents. Their views have been reflected within this report. Documentation was also viewed which is referred to in the evidence section of this report. Not all core standards were assessed during this visit. Those outstanding will be assessed during the remainder of this regulatory year. For a full overview of the service the reader should refer to both reports. What the service does well:
Residents have a care plan which clearly details their needs. This is important, as staff need clear written instructions to follow. Observing staff showed that trusting relationships have developed between them and the residents. During discussions residents spoke fondly of the staff making comments such as “ they’re very kind and patient” and “ If I need something I only have to ask”. One resident confirmed that they never felt embarrassed when staff are delivering care. All confirmed that they believed that staff respected their privacy and dignity. Staff respond quickly to changes in the residents health needs. Doctors, District Nurses and other Health care professionals visit the home regularly. Residents confirmed that they believe that staff had the skills to meet their needs and that staff did respond quickly to changes in their needs. This shows that residents feel as though they are in safe hands. A member of staff commented that “on and off” she had worked at the home for sixteen years. It was stated” its good here, so I always end up coming back” A discussion was held with one resident whose needs are not being met by the home. This is not through lack of trying. The resident confirmed that she has received support with many different types of treatment whilst residing at the home. The manager has recognised that options have been exhausted and has organised a review to take place with the resident’s social worker. This review will focus on whether Thornton Leigh is the best place for the resident to reside and shows the willingness of the manager to ensure residents receive the care that they need. Medications are managed well by the home. Only senior care staff administer medications and have had training on how to do so. A monitored dosage system is in place for medication administration. These precautions reduce the risks of mistakes occurring. Thornton Leigh Care Home DS0000021485.V270940.R01.S.doc Version 5.0 Page 6 Staff were observed tending to laundry and supporting residents with morning drinks. Each resident has their own set of towels and personal cup. This helps to add to the homely ethos and greatly reduces the risk of cross infection occurring. A nutritious home cooked menu is available to the residents. As the home is small the chef is able to familiarise himself with residents likes and dislikes and is therefore able to offer alternatives to the main menu. During the visit staff were seen supporting residents with their lunchtime meal. This was taken in the dining room, and was unhurried. The meal looked attractive and was nutritious. Residents commented that the food was “ wonderful” and “ nothing is too much trouble”. Each resident is encouraged to personalise his or her bedroom to make it feel like home. Different decor schemes exist which help to promote individuality. The building is generally well maintained and presents as a comfortable clean place to live. Domestic staff are available every day. What has improved since the last inspection? What they could do better:
Some care plans viewed were reviewed regularly however one was not. This should be addressed to ensure staff have access to up to date instructions. If residents needs do not change then this should be recorded in the plan to show that needs have been reviewed. The manager was not on duty on the day of the visit. Nutritional risk assessments could not be found. These should be developed (if not in existence already) to help to identify potential weight loss problems, which could indicate deterioration in health. Thornton Leigh Care Home DS0000021485.V270940.R01.S.doc Version 5.0 Page 7 The service provides a menu of a good standard however this is not displayed in the main areas of the home. This should be addressed so that residents are informed of what is being prepared each day. The owners should consider redecorating bedroom 6 and the ceiling to bedroom 8. The walls in bedroom 6 had become marked in places and a stain was noted on the ceiling to bedroom 8. 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 Leigh Care Home DS0000021485.V270940.R01.S.doc Version 5.0 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 Leigh Care Home DS0000021485.V270940.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards were assessed from this section on this occasion EVIDENCE: Thornton Leigh Care Home DS0000021485.V270940.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): 7,8,9,10 Staff have access to clear written instructions regarding the residents needs. Resident’s health needs are met. Medicines are managed safely. Staff respect residents dignity and privacy. EVIDENCE: Three care plans were viewed. Each contained clear instructions of how to meet the health needs and social needs of the residents. Two plans had been reviewed monthly. Another had been reviewed twice in three months. Each contained a photograph of the resident for identification purposes. Staff are recording daily and these records were found to be clear and legible. Each resident has manual handling risk assessments, which details the support required to aid mobility. The risk of pressure sores occurring is also identified on the plan of care. Nutritional risk assessments could not be found but as the manager was not on duty these may have been stored elsewhere. The plans contained clear details of visits by Doctors and District Nurses. Viewing records showed that the home quickly asks for advice when a resident becomes ill. Three residents confirmed that they believed that the staff had the skills to meet their health needs and that they were quick to respond if required.
Thornton Leigh Care Home DS0000021485.V270940.R01.S.doc Version 5.0 Page 11 Staff were observed administering medications which they did safely. A monitored dosage system is in place, which was viewed. The medicine trolley was clean, tidy and well organised. Staff were recording all administration on medication administration records. Observing staff showed that trusting relationships have developed between staff and residents. Staff were seen to be kind and courteous and to support residents appropriately. All residents spoken with confirmed that staff respect their privacy and dignity. Thornton Leigh Care Home DS0000021485.V270940.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): 12,13,15 The service recognises the need to offer regular activities. Vistors are free to visit when they choose according to individual residents needs. The service provides a nutritious home cooked diet. EVIDENCE: Activities have been developed further since the last inspection. A notice board had forthcoming activities displayed. A resident confirmed that participation in activities is not compulsory but “ its nice to know there is something going on” An appointment diary was viewed which showed that many families take their loved one out. Visitors are free to visit when they choose providing it’s not late at night. Families are requested to notify the home when they are taking somebody out so that staff can ensure that the resident is prepared and has necessary care needs met (such as medication) Menus were viewed which showed that an appetising range of meals is provided. The chef confirmed that these are home cooked. The chef stated that he knew the resident’s needs/likes dislikes and therefore provided alternatives accordingly to the main menu. A discussion with a resident confirmed this to be true. The menus are held in the kitchen. No menu was on display for the residents to view. Thornton Leigh Care Home DS0000021485.V270940.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): No standards were assessed from this section on this occasion. EVIDENCE: Thornton Leigh Care Home DS0000021485.V270940.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): 19,26 The home is a comfortable clean place to live. EVIDENCE: A tour of the environment was undertaken. Communal areas were bright, nicely furnished and decorated to a good standard. Since the last inspection both lounges and the dining room have been redecorated. Many homely touches are evident such as cushions and pictures, which help to add to the atmosphere. All bedrooms were viewed. These are decorated individually and are personal to each resident. The majority were found to be in a good decorative state however room 6 – walls above radiator were marked and also the wall next to the bed, Room 8 – patch on ceiling which requires redecoration. Off duties showed that domestic help is available daily with two staff available six days a week. Everywhere viewed was clean, tidy and smelt pleasant. Thornton Leigh Care Home DS0000021485.V270940.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): No standards were assessed from this section on this occasion. EVIDENCE: Thornton Leigh Care Home DS0000021485.V270940.R01.S.doc Version 5.0 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 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): No standards were assessed from this section on this occasion. EVIDENCE: Thornton Leigh Care Home DS0000021485.V270940.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X 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 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Thornton Leigh Care Home DS0000021485.V270940.R01.S.doc Version 5.0 Page 18 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. Standard Regulation Requirement Timescale for action 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 2 3 4 Refer to Standard OP7 OP8 OP15 OP19 Good Practice Recommendations The manager should try to ensure that all care plans are reviewed monthly If nutritional risk assessments are not in place then these should be developed and implemented for each resident A copy of the menu should be displayed near the communal areas to remind residents of options available. Bedroom 6 and the ceiling to bedroom 8 should be redecorated. Thornton Leigh Care Home DS0000021485.V270940.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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