Inspection on 11/07/06 for Thornton Lodge (105)

This inspection was carried out on 11th July 2006.

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

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

Other inspections for this house

Thornton Lodge (105) 27/01/06

Thornton Lodge (105) 08/09/05

Thornton Lodge (105) 31/01/05

Thornton Lodge (105) 10/05/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOMES FOR OLDER PEOPLE Thornton Lodge (105) 105 Brigstock Road Thornton Heath Croydon Surrey CR7 7JL Lead Inspector Peter Stanley Key Unannounced Inspection 11th July 2006 9:30am 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 Lodge (105) DS0000025860.V301368.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 Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thornton Lodge (105) Address 105 Brigstock Road Thornton Heath Croydon Surrey CR7 7JL 020 8684 1056 020 8689 5885 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 Chatrapal Juwaheer Mrs Pauline Rosina Juwaheer Mr Ravindranath Dosieah Care Home 33 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (0) of places Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. For people with a mental disorder who are over 65 and in agreed circumstances those who are over 55 27th January 2006 Date of last inspection Brief Description of the Service: Thornton Lodge is formed of three co-joined, substantial Victorian houses, set amidst the local community of Thornton Heath. Being on the main road through this district - with shops, pub and the local library across the road and public transport connections either outside the door (busses), or just down the road (Railway station and major bus terminus), the homes location could hardly be bettered. As a contrast to this hustle and bustle, the back gardens to the home - separate and yet interconnected - provide an oasis of calm for service users who want to find their way to the quiet and peace of a protected environment. The service provided at the home ensures care with bed and full board for up to 33 people with past or present mental ill health. The registration of the home allows principally for those over pension age - but also includes persons of the age of 55 upwards. This extra category allowance allows for those adults who prefer a more mature focus to their living environment rather than sharing with comparative youngsters. The communal rooms are pleasant - plenty of lounges provide both smoking and non-smoking space. There is also a spacious dining area along the back of the house. 31 single bedrooms and one double-occupancy bedroom provide a high level of privacy for users. Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of the home took place over one day. The registered manager, Mr Ravindranath Dosieah, assisted throughout the course of the inspection, with some assistance being provided by the registered provider and owner, Mr Chatrapal Juwaheer. The inspector spoke to a large number of service users, and to staff on duty. Care assessments, care plans, risk assessments, staff files, accident/incident and complaints records, and other documentation were all examined. The inspector’s overall impression is that this is a well run home, which provides a caring and homely environment for the home’s residents. Feedback from service users and staff was generally favourable, with many positive comments being made regarding the home and the support provided. Overall the inspector found Thornton Lodge to be a comfortable, relaxed and well managed home. The staff on duty at the time of the inspection presented as supportive and enabling, and were observed to be interacting with service users in a caring, respectful and professional manner. The home has addressed all but two requirements from the previous inspection. As a result of this inspection there are 4 requirements and 5 recommendations that will need to be addressed. What the service does well: Each service user is being provided with a copy of their contract or terms and conditions at the point of moving into the home. The home is able to demonstrate that service users needs are being properly assessed, and that the range of needs presented is being appropriately met. Prospective service users, their relatives and friends are provided with the opportunity to visit and assess the quality, facilities and suitability of the home. Service users are having their health, personal and social care needs set out in an individual plan of care, the service user and his relative(s)/representative(s) being involved in this process. Service users are being treated with respect and their privacy is being maintained. Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 6 Service users are being provided with a varied range of socially and culturally appropriate recreational and social activities, the opportunities for their participation having been extended since the last inspection. Service users are encouraged to maintain contact with their family and friends and to retain links with the local community. Service users are assisted to exercise a fair degree of choice and control over their day-to-day routines and decision-making. Service users receive a wholesome, varied and balanced diet in pleasant surroundings. The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and service users and their relatives/friends are encouraged to raise any concerns they may have. Service users’ legal rights are being protected. Service users are being protected from abuse by the home’s policies, procedures and practice. All staff have completed statutory adult protection training. Service users live in a safe, well-maintained environment, with access to safe and comfortable communal facilities. Service users have sufficient and suitable toilets and washing facilities. Service users’ rooms are safe, comfortable and pleasantly decorated, reflecting service users’ personal identities, and being suited to their individual needs. The home presents as being clean, pleasant and hygienic. All staff at the home undertake infection control training. The home has the numbers and skill mix of staff sufficient to safely meet the needs presented by the home’s service users. Staff are being provided with the necessary induction and training with which to competently perform their work duties. All staff are being provided with training specific to the needs of service users who present mental health problems and challenging behaviour. The home is being managed in the best interests of the home’s service users. The management approach is evidenced to be open and enabling, and conducive to creating a positive and inclusive atmosphere in the home. Generally, the health, safety and welfare of service users and staff are being appropriately promoted and protected. Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The home has been developing its quality assurance processes, and is evidencing extensive consultation with service users, relatives and other parties. However, a development plan, outlining the audit outcomes, and plans to address these, needs to be evidenced. Please contact the provider for advice of actions taken in response to this Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 9 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 Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 10 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 to 5 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Each service user is being provided with a copy of their contract or terms and conditions at the point of moving into the home. The home is able to demonstrate that service users needs are being properly assessed, and that the range of needs presented is being appropriately met. Prospective service users, their relatives and friends are provided with the opportunity to visit and assess the quality, facilities and suitability of the home. EVIDENCE: Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 11 The home has a Statement of Purpose and Service User Guide in place. These have been recently reviewed, and provide prospective service users with the information they require with which to make an informed choice about the home. A written service user agreement, outlining the terms and conditions of the placement, is drawn with each service user who is admitted to the home. The service provides care for service users who have long-term chronic mental health histories. It does not accept emergency admissions or provide an intermediate care service (standard 6). New service users are only admitted on the basis of a full assessment undertaken by a person who is suitably qualified to do so. The assessment is done with the service user, relative or delegated representative and relevant professionals that have been party to the referral. Since the last inspection on 27/1/06 there have been three admissions to the home, all of whom were referred by health and social services. The practice of the home is for the manager of the home to complete an assessment of the prospective service user prior to admission. The inspector examined the service users’ files and found that all relevant health and care management assessments had been obtained, and that the home’s pre-admission assessments and risk assessments had been completed. The inspector spoke with two recently admitted service users. Their response was favourable, and indicated that they had settled well and were broadly satisfied with the support being provided. One service user, recently admitted from hospital, said how much better he was feeling in himself since his move into the home. A number of other service users also spoke with the inspector. The feedback received indicated that their individual and collective needs are being generally well met in this home, and that staff are perceived to be caring and supportive. The inspector’s observed staff interacting with service users in a caring and enabling way, displaying relevant support and communication skills, and being professional in their approach. Generally, the home is demonstrating the capacity to meet the assessed needs of individuals admitted to the home. Individual needs, and specific social and cultural needs, are identified in care plans, and these are being addressed. Care plans are being reviewed on a monthly basis, and care reviews are being held. The manager advised that the home’s procedure following a referral is for the person being referred to be invited to visit and spend a day at the home, to have lunch and meet with staff and service users. There is initial discussion around the person’s needs and expectations, and information provided regarding the home’s routines and activities, community facilities, and any house rules that apply. A second visit, with an overnight stay, can subsequently be arranged if required. If wishing to proceed with an admission, a date for a pre-assessment, involving the prospective service user and his/her Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 12 nearest relative or friend/representative, is arranged, and a date set for his/her admission. The admission is then subject to a 28 day trial period, followed by an initial review, at which the service user is involved in discussion as to how he/she finds the home, and whether or not he/she wishes to stay; a decision is then taken on whether to make the placement permanent. Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 13 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 to 10 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are having their health, personal and social care needs set out in an individual plan of care, the service user and his relative(s)/representative(s) being involved in this process. Service users are being protected by the home’s medication policy and procedures. Accredited medication training has been extended to all those care staff who administer medication. Service users are being treated with respect and their privacy is being maintained. EVIDENCE: Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 14 Following the initial assessment, and prior to admission, care plans are drawn up by the home. These are being reviewed on a monthly basis and involve the service user and/or relatives. The plans set out the individual needs of the residents and how the home aims to meet them. Service users are fully involved in the drawing up of their care plans and sign these. There is also a statutory annual review for each service user. The inspector examined care plans for a number of service users, including the three recent admissions. These detail comprehensive information regarding service users’ mental health, physical health, care and support needs, and the actions required to address these. Risk assessments include some covering issues as well as manual handling. Such assessments are carried out by senior staff and are reviewed on a regular basis. The home consults with service users in drawing up their care plans, but needs to move towards involving individuals more fully by adopting a person-centred care planning approach and drawing up person-centred care plans. A recommendation applies. The home is registered with a local health centre with GPs visiting as and when required. Both male and female GPs are available to service users, most of whom are registered with the practice. The home enjoys a good relationship with the health centre. Service users are, however, able to remain registered with their previous GP if they so wish. Local district nursing services are provided as appropriate, as are visits from the local Community Psychiatric Team. Community dentists and opticians attend on a 3-6 monthly basis, and an NHS Chiropodist visits every three months. Service users spoken to by the inspector indicated that their physical and mental health care needs are being well met. Service user records indicate that there is regular monitoring of service users’ health care needs, with files including details of visits to/from the GP, the district nurse, hospital and other appointments. The home’s medication policy and procedures were last reviewed in August 2005 and have been evidenced to provide the necessary level of protection for service users. All medication records examined on the previous and present inspections have been found to be accurate and well maintained. Advice from a pharmacist concerning the home’s policies and procedures is given on a three monthly basis, the last visit having taken place on 17/05/06. An accredited medication training programme is in place within the home, this being ratified by a major local pharmacy. 15 staff have so far completed this training, and 2 others are scheduled to complete this. The inspector was assured that only staff who have completed this training are authorised to assist with medication. No service users are currently administering their own medication, though one service user is able to use an inhaler. Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 15 The inspector has, on previous inspections, spoken to many of the home’s service users regarding respect for their privacy. Views expressed on this visit again indicated that staff are generally being respectful and considerate of their service users’ privacy. This was borne out through the inspector’s observations during the inspection, with staff presenting as courteous and considerate towards service users in their interactions. Comments cards received from a number of relatives indicate that the home is well regarded and that they are made to feel welcome when they visit the home.The home has appropriate facilities available for receiving visitors. This includes a small meeting room for service users who may wish to meet privately with professionals, friends or relatives. A small dining area on the first floor, and the conservatory off the dining area, are other suitable areas for this purpose. A public telephone is available in a hooded acoustic location. Service users are able to use their rooms at any time of the day or night. Service users can generally be assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The home recognises that service users may pass away unexpectedly whilst in residence and staff are given all the necessary information through policies and procedures if such an event occurs. Service users and relative’s wishes in the event of death and funeral arrangements are duly noted in each file. There has been one death at the home within the last twelve months. The home is not able to specifically cater for the needs of older people who are terminally ill, or who require nursing or palliative care. Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 16 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): 11 to 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are being provided with a varied range of socially and culturally appropriate recreational and social activities, the opportunities for their participation having been extended since the last inspection. Service users are encouraged to maintain contact with their family and friends and to retain links with the local community. Service users are assisted to exercise a fair degree of choice and control over their day-to-day routines and decision-making. Service users receive a wholesome, varied and balanced diet in pleasant surroundings. EVIDENCE: The inspector spoke to a number of service users during the inspection. This indicated that there are daily activities available, though some service users Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 17 prefer to go out or spend time on their own. There are, however, opportunities for service users to participate in a range of activities, both within the home, or by going out and accessing facilities in the community. Staff members regularly accompany service users to shops and out for coffee. There is a daily activities hour between 11 and 12 pm. This can include quizzes, bingo, board games, art and drawing, reminiscence and music sessions. The home has been making efforts to extend the range of activities on offer and to develop the abilities of staff in facilitating activities. One senior care worker is developing reminiscence work with service users. While activities tend to be confined to the daily activity hour, there has been some attempt to provide stimulation at other times. The inspector was advised that staff assist in facilitating group discussions and musical sessions. And that two student volunteers visit at weekends, engaging residents in conversation, and escorting individual users for a walk in a local park. One volunteer provides some entertainment by playing the piano in the main lounge. Service users spoken to by the inspector indicated that they have considerable freedom to go out or to participate in activities if they wished. Staff members regularly accompany service users to shops and out for coffee. Some service users are able to go out with family and friends, and receive visitors. The home has an open door policy in relation to visitors, as long as the service user agrees to the visits. The home has a visitor’s room and pleasant garden where residents can receive visitors. The home has regular monthly resident’s meetings, which cover issues in relation to the running of the home. The home organises occasional outings, a day trip to Brighton being planned towards the end of July. Relatives and friends can accompany service users if they so wish. Service users are assisted to exercise choice and control over their lives. Service users are encouraged to express their individuality by maintaining their previous activities and interests, and by furnishing and using their rooms as their very own. Service users’ rooms reflect individual identities, with residents bringing their own furniture, furnishings, photographs and possessions. Most service users have their finances managed by social services or relatives. The proprietor acts as agent/appointee for two service users, records of service users’ personal allowances being maintained. Information concerning service user’s access to advocacy services is available if required. The inspector observed service users being served lunch. This is served in a pleasantly arranged dining area. The food presented as being wholesome and nutritious with meat and fresh vegetables being served. Service users expressed their satisfaction with the food that is provided, with good sized portions being available. Choice is established at coffee time on the morning of the meal. Menus evidenced a varied range of food, and a choice of main dishes each day. Hot drinks and snacks are available at all times of the day. Service users are weighed regularly and special dietary needs (light diet / diabetic Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 18 needs) are appropriately responded to. Catering routines were generally good, with records of fridge and freezer being satisfactorily maintained. Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 19 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 to 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and service users and their relatives/friends are encouraged to raise any concerns they may have. Service users’ legal rights are being protected. Service users are being protected from abuse by the home’s policies, procedures and practice. All staff have completed statutory adult protection training. EVIDENCE: Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 20 The home has a clear and satisfactory complaints policy and procedure. The complaints procedure sets out the process for managing complaints and ensures they are dealt with promptly and effectively. The procedure states that any complaint will be responded to within twenty-eight days, and that any complaint can be referred to the CSCI, local office at any time during the course of investigation. The complaints book at the home details the outcome of any investigation and what action (if any) was taken. No complaints have been recorded since the last inspection. Service users’ legal rights are being protected by the home. Most service users have their finances managed by social services or relatives, though the provider acts as an agent/appointee for two service users. Records of service users’ personal allowances are maintained, these being inspected and found to be in good order. All service users are registered on the electoral roll and assistance is given to enable service users to vote in elections, including the use of postal voting. Advocacy services are available to be accessed as and when the need arises. The home has an Adult Protection and Whistle Blowing Policy in place for staff to reference should the need arise. These provide clear guidelines regarding the nature of abuse and the actions to be taken when an incident of abuse occurs or is suspected. The provider informed the inspector that four staff, who had not previously attended statutory adult protection training, have now done so. A recommendation for the registered manager to attend an accredited ‘Training for Trainers’ training course on adult protection has not, as yet, been acted upon. This would enable adult protection training to be cascaded to staff within the home. The inspector spoke to a number of service users. This indicated that service users feel safe and protected in the home, and that they have generally positive and trusting relationships with staff. Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 21 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 to 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a safe, well-maintained environment, with access to safe and comfortable communal facilities. Service users have sufficient and suitable toilets and washing facilities. Service users’ rooms are safe, comfortable and pleasantly decorated, reflecting service users’ personal identities, and being suited to their individual needs. The home presents as being clean, pleasant and hygienic. All staff at the home undertake infection control training. EVIDENCE: Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 22 The home was inspected and found to provide a pleasant, safe and wellmaintained environment for the home’s service users. Service users presented as comfortable and happy with their surroundings, with favourable comments being received about the home and the facilities provided. The home is currently being extended with an annexe which will increase the number of places and provide additional facilities. The home presents as comfortable, homely and pleasant, with three separate lounges being provided (one for smokers), a main dining area and a small, quieter one (on the first floor). The first floor lounge is, however, due to be converted into another bedroom as the existing room of a service user is to be incorporated into the link to the planned extension. There is a pleasant conservatory overlooking a pleasant garden, which service users are encouraged to access. Two service users, both smokers, were observed sitting in the garden during the inspection. There are 31 single rooms and 1 double bedroom for the 33 service users. The double bedroom is to be converted into two single bedrooms as part of a planned expansion of the home. A new annexe is presently under construction. All bedrooms have a lockable facility. A number of service users’ bedrooms were inspected and found to be comfortably and pleasantly furnished, and in a good decorative state. Service users spoken to by the inspector expressed satisfaction with their rooms and with their living environment within the home. There is an ongoing programme of decoration and maintenance at the home. Since the last inspection there has been extensive redecoration of the home, both the front and back of the home having been redecorated. There has also been internal redecoration of the hallway and corridors, and just under half (15) of service users rooms have been redecorated. There are five bathing facilities at the home in total: a Parker Bath, three hoisted baths (one electric, two manual), and a seated shower adapted for people with disabilities. This, based on the 1:8 ratio, provides facilities - well over the ratio required by the national standard for newly registered premises for the number of 33 service users. Toilets are positioned throughout the home, six being available on each floor of the house. The home is generally well provided for with regard to measures to minimise cross-infection. Laundry facilities, including a sluice-cycle and disinfection-cycle washing machine, are sited in the basement. Sluice facilities are provided separately from the service users’ toilets, and are regularly maintained to ensure the full sterilisation of commode pans and bottles. Hand washing facilities are prominently sited as necessary around the home. The home was generally found to be clean, hygienic and free from any offensive odours. The inspector understands that six staff have received Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 23 infection control training. This is an ongoing area of training with all staff being required to complete this training. The home has sufficient heating, all radiators within the home either being low surface temperature radiators or enclosed with appropriate covers. The home is maintained at a comfortable temperature and service users are able to adjust the heating level in their rooms. The home is well ventilated throughout. Lighting throughout the home presents as satisfactory in all areas, and suited to the needs of the service users. Emergency lighting is provided throughout the home and regularly maintained, along with the fire alarm system. All hot water storage tanks and pipe work is maintained with regard to the prevention of Legionella poisoning, through sterilisation and correct temperature maintenance. Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 24 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 to 30 The home has the numbers and skill mix of staff sufficient to safely meet the needs presented by the home’s service users. The home’s service users are being protected by appropriate recruitment policy and procedures Criminal records checks are now being satisfactorily completed. Staff are being provided with the necessary induction and training with which to competently perform their work duties. All staff are being provided with training specific to the needs of service users who present mental health problems and challenging behaviour. EVIDENCE: Staffing levels are in accordance with the original agreement prior to the Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for older people. This will necessitate a commensurate increase in staffing when the planned expansion of the home is under way, and should also take into account any increase in the dependency levels of the current service users. The home currently has the numbers and skill mix of staff sufficient to meet the needs presented by the home’s service users. The home currently has 23 care staff and 3 ancillary staff. The inspector viewed staff rotas. These Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 25 confirmed that were sufficient staff on duty, with 5 on duty throughout the day and 2 waking and 1 sleep-in overnight. The home currently has 12 care staff who hold an NVQ Level 2, with a further 5 staff registered to study for an NVQ Level 2. this represents approximately 50 of the staffing complement and meets the minimum ratio of 50 trained members of staff with NVQ Level 2. One senior staff member has completed an NVQ level 3, while another is due to register for study leading to this award. The inspector was advised that the registered manager is currently undertaking study for the A1 A2 assessor’s course as had been previously recommended. The home has developed a Training and Development Programme. All staff appointed to the home receive a structured induction programme, based on TOPPS (renamed Skills For Care) standards, with evidence being gathered to support assessment for NVQ level 2. The home has a learning package that covers training in Moving and Handling, First Aid, Health and Safety, Fire Safety and Basic Food Hygiene. The inspector was advised that 20 staff have recently completed training in mental health awareness, and 15 staff have done training in coping with aggression. There has also been ongoing training of staff in medication, adult protection, moving and Handling, food hygiene, infection control and first aid with 14 staff having completed First Aid training. Two new staff have been appointed since the last inspection. The inspector completed checks of staff files and found that up-to-date CRB (Criminal Records Bureau) and POVA checks had been completed, together with all necessary employment and identity checks. Following a previous recommendation, staff files are now including a checklist at the front of the file, detailing the recruitment and identity checks required and the date when these have been completed. Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 26 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): 31, 32, 33, 36 and 38 The home is being managed in the best interests of the home’s service users. The management approach is evidenced to be open and enabling, and conducive to creating a positive and inclusive atmosphere in the home. The home has been developing its quality assurance processes, and is evidencing extensive consultation with service users, relatives and other parties. However, a development plan, outlining the audit outcomes, and plans to address these, needs to be evidenced. Service users best interests are being protected by regular and appropriate supervision of staff. The manager and four senior staff have undertaken supervision and appraisal training. Generally, the health, safety and welfare of service users and staff are being appropriately promoted and protected. EVIDENCE: Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 27 The registered manager, Mr Ravindranath Dosieah, presents as suitably qualified and experienced to run the home. He has a great deal of management and supervisory experience working with vulnerable people in different settings, and has recently completed studies leading to the award of NVQ Level 4 and the Registered Managers Award. The inspector was informed that he is currently studying for an A1 and A2 NVQ Assessors award. The inspector spoke with both staff and service users, and received much favourable comment regarding the running of the home. The home is viewed as being generally well managed, with the home’s manager being well regarded by both service users and staff. A number of comments cards received from relatives confirmed this view, with relatives indicating their satisfaction with the home and the care provided. From the inspector’s observations, and the feedback provided, the management style is one that encourages openness and inclusivity, being both supportive and enabling in its approach. Throughout the course of the inspection staff were observed to interact well with service users and to work together effectively as a team. Service users are, wherever possible, encouraged to participate in the day-today operation of the home and to express their views through monthly service user meetings, care plan reviews and informal discussions with their key worker or other staff. Staff have the opportunity to express their views in monthly staff meetings, and are consulted within supervision. The inspector’s impression, from the feedback received, is that staff feel generally well supported in carrying out their duties The home has been developing its quality assurance processes. The views of relatives are obtained by means of phone contact, invitations to reviews, and visits to the home, where relatives are able to meet and talk directly with care staff and the manager. Service users’ meetings are held on a regular monthly basis, the minutes of recent meetings being evidenced. The home has developed Service User and Staff Satisfaction surveys, together with a Stakeholders Rating Survey. The home has circulated questionnaires to service users, relatives and others, to obtain their views on a wide range of issues relating to the quality of care, support and services provided in the home. An annual quality assurance review was completed in November 2005. The requirement for a Development Plan remains to be met. The registered provider, Mr Juwaheer, assured the inspector that this has been completed, but a copy of the Plan was not available and this needs to be evidenced. Service users are encouraged to be aware of their financial circumstances and are kept informed regarding any proposed changes in fees or outgoings. Most service users have their finances managed by social services or relatives. The Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 28 proprietor acts as an agent/appointee for two service users. Records of service users’ personal allowances are appropriately maintained, with both the responsible person and the service user signing for each transaction that takes place. All receipts of monies and valuables, held on behalf of service users, are being recorded. The home now has a supervision process in place, which covers all the elements of standard 36.3. The frequency of supervision has increased, in line with Standard 36.2, and is now occurring on at least a bi-monthly basis. The inspector was pleased to note that this improvement has been sustained since the last inspection. The inspector understands that the manager and four senior care workers have now attended LB Croydon’s supervision and appraisal training. In line with a previous recommendation, the manager confirmed that it is hoped to delegate supervision, with view to sharing the supervision workload and promoting the professional development of staff. The inspector was pleased to see that a more detailed supervision format has been developed, thus providing a more structured and detailed record of supervision than was previously the case. The inspector completed health and safety checks. These were generally found to be up-to-date and satisfactory. Two inspections, for Health and Safety (last completed 18/3/03), and Environmental Health (last completed 14/10/04) need, however, to be updated. Requirements apply. All services, equipment and facilities are evidenced as being maintained in a safe state to ensure the health and safety of the service user and staff. New staff receive information on health and safety as part of their induction, and foundation training updates are facilitated. The manager ensures that there are safe working practices in the home, which includes moving and handling techniques for the safety of service users and staff. Risk assessments for safe working practices are also carried out. Food and hygiene procedures ensure the safety of staff and service users, and staff attend ‘approved’ infection control training. The inspector examined the incidents and accidents record, and evidenced that accidents and incidents are being recorded in an appropriate manner. A fire risk assessment and emergency plan have been put in place, and fire safety training is carried out every twelve months by an ‘approved company’ to ensure that all staff are clear of what actions to take should take if such an event occurs. The home had a fire inspection on 18/5/06, and fire drills are held every 3 months, the most recent on 18/5/06. Fire alarms are being tested on a weekly basis. Fire awareness and training is seen as paramount at this home although the inspector suggests that fire training is carried out at least every six months in line with recommendations from the local fire service. Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 29 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 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 3 3 3 3 3 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 2 X 3 3 X 2 Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 OP30 Regulation 18(1)a & c Requirement Training must be provided in two key areas: Working with service users who present mental health problems; and Working with service users who present challenging behaviour. Nearly met; of 26 staff, 20 have so far completed this training. Time-scale extended. 2 OP33 24(1)(2)( 3) A development plan, outlining the quality assurance audit outcomes, and plans to address these, must be put in place. Time-scale extended. A copy of the report must be forwarded to the CSCI. The home must arrange for an up-to-date Health and Safety inspection (last completed 18/3/03). The home must arrange for an up-to-date Environmental Health inspection (last completed 14/10/04). DS0000025860.V301368.R01.S.doc Timescale for action 31/08/06 30/09/06 3 OP38 13(4)(a) & (c) 13(4)(a) & (c) 31/10/06 4 OP38 31/10/06 Thornton Lodge (105) Version 5.2 Page 31 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 Refer to Standard OP7 OP16 Good Practice Recommendations The inspector recommends that the home develop ‘personcentred’ care plans in line with PCP guidelines. The inspector recommends that the home provides the opportunity for a senior care worker to attend Croydon’s ‘Training for Trainers’ course in adult protection. This will enable Croydon’s training in adult protection to be cascaded to all staff within the home. Policies and procedures adopted by the home should be reviewed every 12 months by the registered persons. To assist in monitoring this, a checklist detailing when each policy and procedure was last reviewed, should be maintained. 4 OP28 The inspector recommends that the senior care worker, who is currently qualified to NVQ Level 2, has the opportunity to attend training leading to NVQ Level 3. The inspector recommends that there is some delegation of the supervisory workload to two senior care workers. To facilitate this, the job description requires revision so as to include supervisory responsibilities. 3 OP37 5 OP36 Thornton Lodge (105) DS0000025860.V301368.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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