Inspection on 17/05/05 for Thornton Manor Care Home

This inspection was carried out on 17th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Manor Care Home 05/02/09

Thornton Manor Care Home 30/12/08

Thornton Manor Care Home 15/12/08

Thornton Manor Care Home 26/06/08

Thornton Manor Care Home 11/07/07

Thornton Manor Care Home 07/12/06

Thornton Manor Care Home 12/05/06

Thornton Manor Care Home 03/11/05

Thornton Manor Care Home 15/09/04

Thornton Manor Care Home 27/04/04

Thornton Manor Care Home 15/12/03

Thornton Manor Care Home 24/06/03

Thornton Manor Care Home 21/11/02

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

CARE HOMES FOR OLDER PEOPLE Thornton Manor Care Home Thornton Green Lane Thornton Le Moors Cheshire CH2 4JQ Lead Inspector John Mills Unannounced 17 May 2005 07:45 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Thornton Manor Care Home Address Thornton Green Lane Thornton Le Moors Cheshire CH2 4JQ 01244 301762 01244 301985 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Barry Potton Mrs Jayne Eileen Shilcock Care home with nursing (N) 47 Category(ies) of Old age, not falling within any other category registration, with number (OP) 47 of places Physical disability (PD) 11 Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service is registered to accommodate a maximum of 47 service users in the category OP (Old age, not falling within any other category) 2. Within the maximum number of service users, no more than 10 people under the age of 65 years may be accommodated within the category PD (Physical disability) 3. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection 15th September 2004 Brief Description of the Service: Thornton Manor is a detached, converted three storey building situated in a rural setting in its own grounds on the outskirts of Ellesmere Port and Chester. It is close to the motorway network but has no access to public transport. There is parking space to the front of the building and gardens to the front, side and rear. Bedroom accommodation is situated on the ground and first floors with a passenger lift and staircase providing access to both levels. All rooms have a hand washbasin and twenty one rooms have en suite toilet facilities. The third floor is used as office space and staff facilities. Day space on the ground floor consists of one main lounge, a separate dining room, a games room and an additional smoking lounge. There is an additional lounge/dining room on the first floor. There are communal assisted bathing facilities and a call bell system is available in all rooms. The home is registered to provide nursing care for older people whose primary needs are due to physical frailty and a small number of adults with physical disabilities. In accordance with the statutory requirements, there are registered general nurses (RGNs) on duty at all times. Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this inspection over 8 hours on 17th May 2005. Also, on the afternoon of the inspection they were joined by a pharmacy inspector who assessed the administration and management of medicines at the home. Inspectors spoke with residents, nursing staff, care staff, housekeeping staff and visiting relatives. The inspection was carried out with the support of the manager. The inspection included the reading of six care plans, the examination of records relating to health and safety and a tour of the home. At this inspection 17 of the 20 core standards were assessed together with an additional 12 of the remaining 18 standards. What the service does well: What has improved since the last inspection? The new cook has improved the preparation and presentation of meals for residents. Wound care is better managed using a wound care index and staff are supported by the tissue viability nurse. Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 6 The appearance of the home has improved with new furniture and carpeting having been bought and areas redecorated. There has been a reduction in the use of agency staff, providing more continutity of care. Communication between staff at shift changes has improved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 6 Assessment procedures before residents move into the home are thorough and allow family members to be part of the process of assessing needs. The home only admits those people whose needs are in keeping with the skills and knowledge of staff working within the home. EVIDENCE: Two of the care plans inspected were of residents who had been admitted to the home in recent months. These showed that a full medical and social worker assessment had been carried out prior to admission being agreed. These records also showed that family members had visited the home to discuss how the home could meet the needs of the residents after being admitted. The home does not provide intermediate care. Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Residents’care plans are not maintained or organised to a uniform standard. There is a poor standard in how the files are maintained and they contain unnecessary paperwork. The complex and various needs of residents are identified within the care plans, with sufficient information for those needs to be properly met. Residents are cared for by staff in a way which that residents appreciate. Medicines are not always managed to the required standard EVIDENCE: A sample of six residents’ care plans were inspected, three from each floor. The care plans are stored in a filing cabinet where they fall on top of one another so are not always easy to find. They are not presented in a tidy manner and contained a number of forms that were not required and had not been completed. They also contained information from several years ago that was not always relevant. Other documents, such as the resident’s TV licence, were filed in one care plan. (See recommendation No. 1) Care plans did contain a range of assessment documents, and where the assessment highlighted a need, a plan of care had been written to address this. Risk assessments had been carried out and care plans had been reviewed on a regular basis. Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 10 Care plans showed that residents are referred to specialist services as required. Residents received regular visits from a physiotherapist. Seven residents on the first floor and four on the ground floor had charts to record food, fluids and re-positioning. Three members of care staff spoken with was able to explain why these individuals had charts and how they were completed. Two residents had pressure sores. Care plans had not been written to provide information for the staff as to how these sores were to be treated, however additional information regarding dressings was contained in a ‘Master Index’ folder. Seven residents said that they “liked the staff who worked at the home and were well cared for and treated properly” There is a lockable room for medicine storage that is very full and needs cleaning. Staff were not paying enough attention to keeping residents’ medicines secure as the drug refrigerator key was in its lock and the trolley tethers were not being used. The drug refrigerator badly needed defrosting. Its temperature was recorded to be minus two degrees centigrade, which is too cold. Staff had not identified that this was outside the normal range of between two and eight degrees. It was not clear whether all the medicines were still needed, for example there was eye ointment that had been dispensed in February but seemed not used. A very few items had date expired. Residents had excessive amounts of medicines. There was evidence of bad practice in medicine handling. Some medicines were out of the labelled container in which they had been dispensed so it was not clear who they belonged to. One residents’ loose inhaler capsules had no directions in English. Containers of one resident’s controlled drug had been moved into one container as it was labelled to contain five when it actually contained seven doses. There were crossings out in the controlled drug records. There were opened vials of insulin in use that had not been marked with the date of opening to comply with the twenty eight day opened shelf life. A residents’ cream, labelled to be stored in a cool place was not in the refrigerator. Records of receipt, administration and disposal of medicines were not always kept properly. These provide evidence that service users are given their medicines as prescribed. There were omitted records of administration. Records of residents who had been prescribed antibiotics suggested that these had not been given as prescribed. An immediate requirement was made about medication at this inspection. (See requirement No. 1) Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Social activities and meals are both well managed, creating and providing daily variation and stimulation for people living within the home. EVIDENCE: Two residents were preparing to leave the home during the morning to attend day care or college. Residents were observed to be assisted getting up at different times throughout the morning and the manager said that no-one got up before 8am unless they requested to. The majority of residents have very serious health needs and have a reduced ability to take part in leisure activities. There is a commitment to employ a specific member of staff to assist the younger residents in the development of life skills and working in the residents’ kitchen. Conversations with residents confirmed their satisfaction with the presentation and content of meals. Following assessment, those residents with complex dietary needs have been provided with specific nutritional supplements. Special diets were observed as being provided and presented in an appetising manner. The new cook had made positive changes to the menus that provided a range of choices and greater variety for residents. Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: None of these three standards were assessed at this inspection. Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 & 26 Improvements have been made to the décor and furnishings within the home, including the purchase of new lounge and bedroom furniture for residents. Residents live within a safe home where a programme of redecoration and refurbishment has begun. Maintenance is ongoing but some work was identified that needs to be prioritised. EVIDENCE: The environment had continued to improve since the last inspection. A new carpet has been laid in the first floor corridors. The first floor lounge has a new carpet and some new armchairs provided for residents. The home’s maintenance person said that he would be decorating this room in the near future. The programme of refurbishment and redecoration needs to continue throughout the home. (See recommendation No. 2) The hot water temperature in the bathrooms was hand tested and found to be delivered at a safe temperature. All bathrooms were clean. One shared Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 14 bathroom contained some personal items of clothing and toiletries belonging to resients that should be more appropriately stored in their own rooms. Bathroom 42 is fitted with a bath hoist. The base of this hoist has peeling paint and the floor immediately around the base was in need of some attention. Bathrooms have been improved by decoration. The addition of a curtain or blind at the window and, in some cases, a light-shade would further improve the appearance and homeliness for the benefit of residents at the home. There were several unoccupied bedrooms that were in the process of being decorated and re-carpeted. Bedroom 45 had been completed and was ready for occupation. There were two pillows on the bed that were very ‘lumpy’. Several similar pillows were seen in the home. The manager said that a number of new pillows had been purchased and said that she would check to see that any pillows in poor condition were disposed of. A number of bedroom doors were fitted with locks. The door of bedroom 56 is damaged and did not self-close. (See requirement No. 2) All areas of the home were found to be clean and there were no unpleasant odours present. The home has a small laundry containing washing machines and tumble driers. The laundry assistant said that a new machine had been very welcome and had improved the service that she was able to provide to the residents. There is a separate room where laundry is ironed and folded. Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 Staff are given a good range of training opportunities covering both mandatory areas and personal developmental subjects. Residents benefit from a service that provides adequate staffing levels and well informed and knowledgeable staff. Records relating to staff employed within the home and the training they received were not properly maintained, neither were they kept in good order. EVIDENCE: On the day of the inspection there were two registered nurses and six carers providing direct care to the residents. Examination of staff rotas showed that these staffing levels were maintained and that no agency staff were being used. Additional staff included the home manager, the maintenance person, a laundry assistant, cook and kitchen assistant. No cleaner was on duty that morning due to holiday, sickness, and a member of staff leaving without notice. The home manager provided information regarding care staff qualifications. Two staff had completed NVQ level 2; five staff had been working towards NVQ level 2 for over a year and had now almost completed; four staff were waiting to commence this qualification in care. Also, six overseas nurses were employed as senior care assistants. Records relating to seven members of staff were inspected. These were kept in loose- leaf folders and so were not presented in any coherent order. Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 16 Criminal Records Bureau disclosures had been obtained for all staff and a health and safety induction had been carried out for all of these staff. There was inconsistency in the other information contained in the staff files. Some staff had a signed contract of employment, some had an unsigned contract, and others had no contract. Some staff had completed a medical declaration but two had not. The folder pertaining to one of the registered nurses contained two personal references but no professional or employer’s reference. The folder of another nurse contained no details of her employment history. None of the staff had a job description or a record of their induction into the home, other than the health and safety induction. (See requirement No. 3) There was evidence from speaking with the manager and staff, and from information seen during the inspection, that the home provided a range of training for staff. Recent training had included food hygiene, first aid, care planning and wound care. However, there were no records to demonstrate exactly who had attended these training events, or to enable the inspector to form an overall impression of how many staff had received training and in what subjects. (See recommendation No. 3) Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36, 37 & 38 Residents live in a well managed service providing them with a good level of safety and security. There is presently no system available to manage a quality assurance system, resulting in there being no structured way for the manager to keep a check on the views of residents, their families or others involved in the home. EVIDENCE: The manager of this service is an experienced trained nurse with additional specialist nursing qualifications. The manager stated that at present there is no quality assurance system in place. If developed this will allow staff, relatives and service users to contribute to a recognised quality assurance system. (See requirement No. 4) Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 18 The financial records of service users were examined and found to accurately record the monies held in trust for residents. The manager was routinely checking these records each month. Records relating to health a safety; fire log book, accident book, hot water temperatures, kitchen records and testing of electrical and mechanical equipment were checked and found to be in order. Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 2 x 3 3 2 3 Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13 Requirement Timescale for action 17/05/05 2. 19 23 3. 30 17 4. 33 & 37 24 The registered perdson must ensure that medicines are handled, administered and recorded properly The registered person must 01/07/05 ensure that the door and dorclosure on room 56 is made safe The Registered person must 01/07/05 ensure that all staff are provided with signed contracts of employment and job descriptions The registered person must 01/09/05 ensure that a recognised quality assuance system is in place 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. Refer to Standard 7 19 30 Good Practice Recommendations Care plans should be reviewd as to content and construction The programme of refurbishment and redecoration needs to be continued Records of staff training events should be maintained in good order and include the names of all those who F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 21 Thornton Manor Care Home attended. Thornton Manor Care Home F51 F01 S18787 Thornton Manor V227154 170505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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