CARE HOMES FOR OLDER PEOPLE
Thornton Manor Care Home Thornton Green Lane Thornton Le Moors Cheshire CH2 4JQ Lead Inspector
Wendy Smith Unannounced Inspection 11th July 2007 9:30 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 Manor Care Home DS0000018787.V339658.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 Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Thornton Manor Care Home Address Thornton Green Lane Thornton Le Moors Cheshire CH2 4JQ 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) 01244 301762 01244 301985 Mr Barry Potton Mrs Patricia Bibby Care Home 47 Category(ies) of Learning disability over 65 years of age (1), registration, with number Mental disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (47), Physical disability (10) Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service is registered to accommodate a maximum of 47 service users to include: * Up to 47 service users in the category OP (old age, not falling within any other category) * Up to 10 service users in the category of PD (physical disability) 2. 3. Within the maximum of 47, 1 named service user in the category LD(E) (learning disability over the age of 65) Within the maximum of 47, 1 named service user in the category of MD (mental disorder) may be accommodated and the care plan to be reviewed monthly to ensure that the individual’s needs are met and that the placement remains appropriate. 7th December 2006 Date of last inspection Brief Description of the Service: Thornton Manor is a three storey building that has been extended and adapted as a care home for older people and people with a physical disability. The home is set in its own grounds in a rural location between Ellesmere Port and Chester. It is close to the motorway network but is not accessible by public transport. There is parking space to the front of the building and gardens to the front, side and rear. The weekly fee currently paid by residents is from £353.91 to £639. Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced visit took place on 11th July 2007 and took seven hours. The home had 42 residents. A tour of the building, including all communal areas and some bedrooms, was completed. A sample of records was looked at and time was spent in conversation with the home manager, residents and staff. Some of the information contained in this report is taken from the Annual Quality Assurance Assessment that was completed by the manager. Comments cards were provided for residents, visitors, social workers and GPs to give their views of the home. What the service does well: What has improved since the last inspection?
The home has a new brochure and a new pre-admission assessment form. The care plans are in a new format that is easy for staff to follow.
Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 6 The home is kept cleaner and looks more pleasant, homely and comfortable. Flooring in the laundry and bathrooms has been replaced and the bathrooms have been made more pleasant for residents. Exterior woodwork is being painted and repaired. A new administrator has been recruited to assist with day to day paperwork. Bedrails were all fitted safely. Most of the requirements and recommendations made in the last report have been addressed in full. What they could do better:
There is still room for improvement in the standard of recording in residents’ care plans to provide evidence that residents’ health is being monitored. All documents should be signed and dated by the nurse writing them to provide accountability and so that people can see when they have been written. Ensure that, when printed instructions are not provided with medicines, staff handwrite all the details from the medicine label onto the record sheet, that these are checked by a second person and that both sign the record and that a separate record of receipt is made. This is so staff have clear instructions how to give residents’ medicines and that there is accountability. A risk assessment must be carried out before any resident administers their own medicines to make sure that this will be safe. A risk assessment must be in place for all residents who have bedrails fitted, to show that this is an appropriate and safe use of restraint. Auditing systems must be thorough and in depth so that any shortcomings in care plans or medicines management are identified. Replace any bedroom furniture that has become shabby and provide more storage facilities for residents’ belongings in their bedrooms. Keep an up to date training matrix to show that all staff have completed mandatory training. Develop policies for first aid, racial harassment, sexuality and relationships, and working with volunteers. Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People interested in coming to live at Thornton Manor have a full assessment to ensure that their care needs can be met. EVIDENCE: Pre-admission assessments are carried out by the manager or the deputy manager before admission is agreed. This ensures that the care needs of the individual can be met at the home. Copies of the assessments were seen in the care plans but they had not been signed or dated so it was not possible to verify who had carried out the assessment or how long before admission they had been carried out. The assessment form used has been updated. The care plans also contained a copy of the social worker’s assessment. Information is provided for prospective residents in a brochure. Thornton Manor does not provide intermediate care.
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The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In general the care needs of residents are met to a good standard, but the care plans need to be more accurately completed to show that residents’ health is monitored and some improvements are needed to medicines management to ensure safe practice. EVIDENCE: Each resident has a plan of care that details how their needs should be met. There is a new format for the care plans which is easy to follow but contains all of the required documents. Unfortunately the care plans had not always been completed thoroughly. Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 11 The ‘core care plans’ were not always sufficiently personalised to reflect the individual, for example the care plan for a resident who smokes instructed staff to ‘provide smoking cessation aids’ although there was nothing to suggest that this was what the person wanted or that it was being done: the care plan for a resident with diabetes did not instruct staff how often her blood sugar level should be tested and did not mention the medication she required. The care plans contain a risk assessment for each of the resident’s needs. This is a positive inclusion but unfortunately the risk assessments had not been signed or dated by the member of staff who had written them or by the resident. Entries made in the daily progress records were good and meaningful. Two residents had a pressure sore and both had been admitted with the sore. Appropriate equipment and care was being provided to relieve pressure. For one of these people there was no entry in the care plan about the wound since 10th June 2007. The nurse on duty was asked about this and said that a district nurse was now looking after the wound, however the home’s staff should be aware of the progress of healing and this should be recorded. One resident was recorded as having lost 3 kilograms in weight over the last month. This had not been followed up. One resident was very ill at the time of the visit. He was being looked after in bed and appeared comfortable and pain-free. Staff were seen to be providing appropriate care for him. The manager confirmed that she can access a tissue viability nurse specialist when required. The home receives a good service from the continence advisor. A number of GP practices provide a service for residents. A comments card received from a GP returned all positive responses and indicated that there had been no complaints. A physiotherapist is employed at the home and her services are provided for residents without any extra charge. Medicines are handled only by registered nurses and in general there are satisfactory arrangements for the ordering, storage, administration, recording and disposal of medicines; however a number of examples were found where safe procedures were not being followed. Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 12 The medicine administration record sheet for a new resident indicated that she administered her own medicines however it was being signed for by staff at each medicine round. There was no risk assessment to show that staff had made sure that this it would be safe for this person to administer her own medicines, and there was no record of what arrangements had been made to ensure safe storage and to monitor whether the person was taking her medicines as prescribed by her doctor. On further investigation it was evident that staff were not clear about the arrangements and that the medicines were not being stored safely. Another resident was taking regular anti-coagulants but there was no care plan for this. One resident was prescribed a tranquilising medication ‘when required’. There was no care plan to tell staff under what circumstances this should be given and for the last few days it had been given regularly twice a day for no apparent reason. There were still some examples of handwritten medicine administration record sheets not being signed or dated and the quantity of medicines brought into the home not being recorded. This means that it is not possible to check whether the medicines are being given as prescribed and that there is no accountability regarding who has written the medicine administration record. A comments card received from a social worker described that when she visited her client: his privacy appeared to be respected. He was in his bedroom with the door closed and staff knocked and waited for a reply before entering. Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise choices in daily living and can participate in social activities both inside and outside of the home. EVIDENCE: An activities organiser is employed for three days a week. On the day of this visit she had taken four residents out for lunch and they said that they had enjoyed it very much. A programme of activities is displayed in the entrance area and showed a variety of events to try and include as many residents as possible. There was evidence that great effort is made to provide good social opportunities for residents. One resident said that he is taken out every week in the home’s minibus to play dominoes. Staff bring in daily newspapers for residents. The manager said that she is planning to have more activities in an evening. Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 14 A new garden area was developed in 2006 and this is set away from the building. Residents can go and sit in the garden on their own, if they are able, or with visitors. The garden and greenhouse are also used for activities. One resident was sitting outside and had a remote call bell. He was confident that staff would come and assist him back inside when he rang. The manager has introduced initiatives to involve families and friends in the day to day life of the home, including relatives meetings. The minibus is used to pick up relatives and to take residents out to visit family. A comments card received from a social worker read: with regard from my client his lifestyle was respected ie he doesn’t sleep well at night so spends time in a lounge in a favoured reclining chair. He is not forced to adopt a routine alien to him. A relative commented that: The care home people have made my relative feel very welcome and content to be where he is. Most residents have brought in a lot of their own belongings to make their bedrooms more personalised. A second laundry assistant has been recruited and it is hoped that this will result in residents’ clothing being cared for more consistently. The menus are continually adapted to suit the preferences of residents and residents spoken with all said that they enjoy their meals. There is always a choice. The lunch served on the day of the visit was of a good standard and fresh produce is used as much as possible. Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints from residents or visitors are taken seriously and acted upon to ensure the protection of vulnerable people. EVIDENCE: Two complaints have been received at the home since the last inspection Good records are kept and showed that the complaints had been investigated and responded to within the agreed timescale. Staff have received training about the protection of vulnerable adults and the prevention of abuse. Policies and procedures are in place. Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortable, clean and safe, but communal space is very limited and there is a lack of storage for residents’ belongings. EVIDENCE: The grounds of the home are pleasant and well-maintained. At the time of this visit painters were working on the exterior woodwork that was in need of attention. A tour of the building showed that the environment overall had continued to improve. There was an odour problem in one bedroom and some of the bedroom carpets were stained. Some of the bedroom furniture is shabby and in need of replacement. Residents who had brought in a lot of their own belongings did not have adequate cupboard space to keep their things in.
Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 17 Flooring had been replaced in the laundry and bathrooms. The bathrooms had been made much more pleasant. The nurses stations on each floor had been refurnished. The lounges and dining room are very crowded with furniture and there is restricted space for people who use wheelchairs. The manager said that she put in an application to fund an extension to the ground floor lounge. The application has been successful and funding is now available for the work to take place. This will make a big difference to residents. Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Enough trained and qualified staff are provided to meet the needs of the residents. EVIDENCE: Staff rotas showed that there are enough staff on duty at all times to meet the needs of residents. During the daytime there is a registered nurse on duty on each floor. Eighteen care staff are employed. Of these, twelve have a national vocational qualification in care and the other six are working towards a qualification. Some of the staff who completed level 2 are now working towards level 3. Recruitment records were looked at for the most recently recruited staff. The records showed that the necessary checks had been carried out to ensure that these people were safe to work with vulnerable people. Staff training in mandatory subjects is on-going. Records are kept in the staff file for each person but the overall training matrix was not up to date which meant that it was not possible to verify whether everyone was up to date. Moving and handling training is provided by the in-house physiotherapist.
Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a competent and experienced manager who has worked very hard to improve standards in all areas. EVIDENCE: The manager has been in post since October 2005 and has completed the registration process with the Commission for Social Care Inspection. The manager is still taking responsibility for the domiciliary care agency that is based at Thornton Manor and it is of some concern that this may divert her time and energy from the care home, however she has continued to take the home forward in all areas. A recent satisfaction survey returned all positive responses regarding the manager and staffs’ attitude.
Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 20 The home now has an administrator who is taking over day to day management of routine paper work. The manager completed the Commission for Social Care Inspection’s Annual Quality Assurance Assessment to a good standard. A recent satisfaction survey of residents and families returned mostly positive responses but there were a few negative comments about laundry and furnishings. Staff meetings have been held in January and May 2007. The manager has delegated most of the auditing of medicines and care plans to one of the nurses. They had not been carried out often enough, or in enough depth, to identify shortcomings. Residents are able to keep small amounts of personal spending money in the home’s safe. The records looked at showed that all expenditure was accounted for and recorded. The manager provided information about when plant and equipment had been tested and serviced. The fire alarm system is tested weekly, the emergency lighting monthly, and the hot water monthly, by the home’s maintenance person. The fire records showed that regular fire drills are held and the names of staff attending were recorded. Bedrails were all fitted correctly and had protective padded covers. A good risk assessment for the use of bedrails had been completed for some residents but not all. The kitchen staff were wearing appropriate protective clothing. The manager said that a good report had been received following a recent visit by an environmental health officer. The kitchen store was clean and tidy. None of the fire doors were propped open and a new smoking policy had been developed to comply with recent legislation. Policies need to be developed for first aid, racial harassment, sexuality and relationships, and working with volunteers. Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 21 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13(2) Timescale for action Ensure that, when printed 18/07/07 instructions are not provided with medicines, staff handwrite all the details from the medicine label onto the record sheet, that these are checked by a second person and that both sign the record and that a separate record of receipt is made. This is so staff have clear instructions how to give residents’ medicines and that there is accountability. (This is requirement inspection.) 2 OP9 13(2) an outstanding from the last Requirement A risk assessment must be 18/07/07 carried out before any resident administers their own medicines to make sure that this will be safe. A risk assessment must be in 31/07/07 place for all residents who have bedrails fitted, to show that this is an appropriate and safe use of restraint. 3 OP38 13(4)(c) Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 23 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 OP7 Good Practice Recommendations Residents’ care plans should provide evidence that residents’ health is being monitored. All documents should be signed and dated by the nurse writing them to provide accountability and so that people can see when they have been written. Auditing systems must be thorough and in depth so that any shortcomings in care plans or medicines management are identified. Replace any bedroom furniture that has become shabby. Provide more storage facilities for residents’ belongings in their bedrooms. Keep an up to date training matrix to show that all staff have completed mandatory training. Develop policies for first aid, racial harassment, sexuality and relationships, and working with volunteers. 2 OP33 3 4 5 6 OP24 OP24 OP30 OP33 Thornton Manor Care Home DS0000018787.V339658.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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