Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Thornton Manor Care Home Thornton Green Lane Thornton Le Moors Cheshire CH2 4JQ The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wendy Smith
Date: 0 5 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home
Name of care home: Address: Thornton Manor Care Home Thornton Green Lane Thornton Le Moors Cheshire CH2 4JQ 01244301762 01244301985 patb@casicare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Barry Potton care home 47 Number of places (if applicable): Under 65 Over 65 1 1 47 0 dementia learning disability old age, not falling within any other category physical disability Additional conditions: 0 0 0 47 The registered person may provide the following category of service only: Care home with nursing: Code N, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP Physical Disability: Code PD Learning Disability (over 65 years): Code LD(E) (maximum number of places 1) Dementia (over 65 years): Code DE(E) (maximum number of places 1) The maximum number of people who can be accommodated is: 47. Date of last inspection Brief description of the care home 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. There are bedrooms, bathrooms and communal areas on the ground floor and the first floor. The second floor is used as office accommodation. 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 Care Homes for Older People
Page 4 of 27 1 5 1 2 2 0 0 8 Brief description of the care home is not accessible by public transport. There is parking space to the front of the building and gardens to the front, side and rear. Care Homes for Older People Page 5 of 27 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. Three inspectors visited Thornton Manor on 5 February 2009 to carry out an unannounced visit there. The reason for our visit was to follow up concerns we had when we visited the home on 15 December 2008, and concerns about the home we had received from health and social care professionals. We looked at care plans and medicines management. We looked at all of the information available about staffing. We walked around the home and spoke with some of the people who live there and most of the staff on duty. We spoke with the manager Care Homes for Older People
Page 6 of 27 and looked at management records, including health and safety records. Before we left we gave feedback to the manager and the home owner about what we had found. What the care home does well: What has improved since the last inspection? What they could do better: Before any new people move in they must have a full assessment of their needs to make sure that this is the right home for them and that the staff have the knowledge and skills to meet their individual needs. Action should be taken to make sure that people know about the homes complaints procedure and how any complaints they may have will be addressed. They should also be informed of the names and contact details of the manager and the home owner so they know who they should get in touch with if they have concerns. Locks that staff can override in an emergency should be fitted to all bathroom and toilet doors so that people can have privacy. Care Homes for Older People Page 8 of 27 Staff should complete the training programme and records should be kept to show that this has taken place. Additional training to ensure that staff have the skills and knowledge to provide care to people who have complex needs should be identified and provided. New staff must not start working in the home until a POVAfirst check has been received. This is to help make sure they are suitable to work with the people who live at the home and that people are protected from possible harm or poor practice. A system of quality auditing, which includes care plans, needs to be introduced to show that a good standard is maintained and that shortcomings are identified and dealt with with the nurses. A system of regular staff supervision and appraisal should be introduced and maintained to ensure there is good communication between each member of staff and their manager. A monthly audit of accidents is recommended as good practice, as this would help to identify when and how accidents are occurring and whether any action can be taken to reduce the number of accidents. The registered person must carry out monthly visits to comply with regulation 26 of the Care Homes Regulations 2001 and send a report to the CSCI and to the home manager. This is to ensure that the registered person is aware of how the home is being conducted. Action must be taken to make sure that the home complies with any requirements and recommendations that are made by the Fire Officer and the Environmental Health Officer so that residents are kept safe. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have moved to live at the home without a full assessment to show that their needs could be met. Evidence: We visited the home on 15 December 2008 to do a short inspection after receiving concerns from health and social care professionals. We found that people living at the home had very diverse needs. Several people required care due to alcohol misuse and one due to drug abuse. A number of people had a learning disability and some had epilepsy. One person had challenging behaviour. Other people had been admitted to the home with a diagnosis of dementia. We were concerned about this for several reasons. We considered that the homes nurses and care staff did not have the knowledge or experience to provide appropriate care to all of these people. We considered that it was not appropriate for people with
Care Homes for Older People Page 11 of 27 Evidence: such different needs to all be living together. We considered that the homes categories of registration had been disregarded and that the assessment of new people to ensure that their needs could be met had not been sufficiently thorough. When we visited on 5 February 2009 there were 31 people living at Thornton Manor. No new people have moved into the home since October 2008. The manager told us that this had helped her to be able to reassess all of the people currently living at Thornton Manor, to recruit more staff, to identify where training is needed and to arrange for the training to be provided. The home owner told us that he intends to apply to change the homes registration categories. Care Homes for Older People Page 12 of 27 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people are met and this is recorded in their care plans to help show that the support being provided is effective. Peoples medicines are well managed to ensure they always receive what has been prescribed by their doctors. Evidence: We looked at a number of care plans for people living on each of the two floors of the home. The care plans have all been rewritten and are neat and tidy in new folders. This makes it easy to find the information that staff might be looking for. All of the old information has been removed and archived. This has been a big piece of work and it is to the credit of the manager and the nurses that they have completed it within a few weeks. Residents needs have been reassessed and plans written for how their needs should be met. In general, we found that the content of the care plans was good and reflected individual needs. Some of the care plans did not have information about the persons
Care Homes for Older People Page 13 of 27 Evidence: life history, family and interests but others did. Wound care was recorded regularly but the manager might consider using a wound chart as a clearer way of presenting the information so that the nurses and other healthcare professionals could easily see how effective the care and treatment being provided was. Individual risk assessments had been completed for all identified risks to the health and safety of the person. This helps to make sure that levels of risk are reduced to help people stay safe. Visits from GPs and other health professionals were recorded, which showed us that peoples health care needs were being met. The nurses make daily entries in each of the care plans. These tend to focus on the physical needs of the person, even for those people who have identified needs with regard to their mental or emotional health and are relatively independent for personal care. Further training may give the staff more confidence to comment on peoples psychological and emotional progress which will help when reviews of support and care needs are carried out, as there will be a record to show how effective the care is. We looked at the storage, administration and recording of medicines. Good arrangements are in place and all medicines, including controlled drugs, were stored appropriately. Recording was very good and showed that people receive their medicines as prescribed. Care Homes for Older People Page 14 of 27 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to use services in the community so they can go out an about from the home. People have a choice of food, so they can have the food they prefer to help keep them healthy. Evidence: The home is in an rural area and transport is provided for people to be able to go shopping or access other community facilities. At the time we visited there were no regular social activities for the people living at the home, however an activities coordinator has been recruited and this should result in more regular social stimulation for people within the home. At lunchtime the meal was nicely served and people were assisted in a sensitive way. People who did not want the main meal were offered an alternative. We were told that from Monday 9 February 2009, a system was to be introduced to keep a record of what people choose to eat. Care Homes for Older People Page 15 of 27 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the manager will take their complaints seriously and measures are being taken to ensure that people are protected from abuse. Evidence: There is a complaints procedure for the home but this needs to be clearly available to residents and their visitors and give them the names of the manager and the home owner so that they know who to contact if they have a complaint or concern. The manager has kept records of complaints that she has dealt with in recent weeks. The complaints file could be better organised to show clearly how the complaint was dealt with and what the outcome was. There are policies and procedures for the home about safeguarding vulnerable people from abuse. The manager told us that she is reviewing these policies and procedures to make sure that they reflect the most up to date guidance. We saw evidence that training about safeguarding is being provided for all staff by a local college. Care Homes for Older People Page 16 of 27 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and comfortable for people to live in and the standard of housekeeping has improved but the restricted communal space available limits peoples choice of where they can spend time during the day. Evidence: We had a look around the home and found it to be clean and tidy. The standard of cleanliness is much improved from what we saw during previous visits. The carpet on the ground floor has been replaced and this has made a big difference in how the home now looks. Re-decoration is continuing. Communal space for people who live at the home is restricted and the conservatory that has been planned for several years has not yet been built. As a significant number of the people who live at the home are wheelchair users, it is important that they have enough space to move around. Also, due to the wide range of people accommodated at the home, a choice in living space is needed so that people can choose where they spend their time and who they spend it with. We noticed that some bathrooms do not have a curtain or blind on the window. Although not needed for privacy as the windows are obscured, these would make the rooms more pleasant for the people using them. Not all of the bathrooms and toilets
Care Homes for Older People Page 17 of 27 Evidence: have a lock, which means that peoples privacy may not be maintained when they are using the bathrooms and toilets. The kitchen was clean at the time of our visit and we saw that the fridge, freezer and food temperatures were recorded regularly to make sure these were all at the correct level for health and safety. There was no copy of the last environmental health officer report to the home (which was in 2008) and the manager has asked for a copy so that she can make sure that any problems identified then are being dealt with. Care Homes for Older People Page 18 of 27 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers have increased and a programme of training is being implemented so that people living at the home can be sure that their needs will be met. Recruitment procedures must be thorough so that people who live at the home can be sure that they are in safe hands at all times. Evidence: When we visited the home in December 2008, we were concerned that only three registered nurses were employed (not including the manager) to cover seven days a week, 24 hours a day. Since then a nurse who was previously employed at Thornton Manor has returned, an overseas nurse has completed the process of registration in the UK, and the manager was hopeful that she had recruited another nurse. The rotas showed that there are three care staff on duty for each floor of the home during the daytime with one nurse, or sometimes two. We looked at recruitment records for new staff to check on how they had been recruited. For the last two staff employed, all of the required checks were carried out before they started working at the home. However for two people who began work at the home in December 2008 it appeared that they had started working before their POVA check had been returned to confirm that they were not on the list of people unsuitable to work with vulnerable people.
Care Homes for Older People Page 19 of 27 Evidence: There was no training matrix (chart) to show when each member of staff had attended training events but we did see plenty of evidence that a full programme of staff training is being provided by a local college and is well underway. It is important to keep accurate records of this training so that the manager knows who has attended and who might have missed important subjects. The records will also show when people are due to have an update of their training. Care Homes for Older People Page 20 of 27 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Record keeping and quality monitoring are improving so that the management of the home can show that the service is being run in the best interests of the people who live there. Evidence: A new manager for the home was appointed in November 2008. She is an experienced registered nurse but this is her first post as a care home manager. We considered that the manager was making good progress in making the improvements that were needed to ensure that the home is run in the best interests of the people living there. The people we spoke with expressed their support for the new manager and considered that the service was improving. There are no established quality assurance systems for the home. The manager said that she will be regularly checking the care plans and medicines to ensure that the good standard achieved is maintained.
Care Homes for Older People Page 21 of 27 Evidence: A meeting for residents and their relatives was held in January 2009 to find out more about their views on the way the home is run. We do not have any record of monitoring visits carried out by the home owner since July 2008 although he was certain that these had been sent to us. There is no system of staff supervision and appraisal but we saw evidence that the manager is starting to set this up to improve communication between members of staff and their manager. Residents are able to keep small amounts of personal spending money in safekeeping at the home. Individual records are maintained to show all expenditure. There is no current fire risk assessment for the home that meets the requirements of the fire officer. The manager told us that she is working on this and is liaising with the fire officer. There have been some concerns about the closing mechanisms on bedroom doors. The home has a significant number of residents who are wheelchair users and wish to be able to move around independently. They need to have appropriate devices fitted to their bedroom doors so that the door can be held open for them to go in and out but will close automatically if the fire alarms go off. Fire safety training was held on 17 December 2008 and 25 staff signed that they attended. Records in the fire log book showed that the emergency lighting is checked monthly and the fire alarm weekly. Record keeping in general has started to improve and we have been kept informed of important events that have happened at the home. Copies of these reports had also been filed. Accident recording was much improved and we saw copies of accident reports in peoples care plans. It is recommended that the manager reviews the accident reports regularly to find out whether there are any measures she can put in place to reduce the occurrence of accidents. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 4 12 The registered person must make suitable provision to ensure that the assessed health and personal care needs of residents can be met at the home. So that people who do not fit the homes registration categories are not admitted to the home, and so that residents assessed needs are met. 05/01/2009 2 29 18 New staff must not work in the home until a POVAfirst check has been received for them. To protect residents from possible poor practice or abuse. 05/01/2009 Care Homes for Older People Page 23 of 27 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 3 14 People must not move into 12/03/2009 the home unless a suitably qualified member of staff from the home has undertaken a thorough assessment to find out what the personal and health care needs of the person are. This is to make sure that their needs can be met at the home and that the home is the right place for them. 2 18 13 All staff must receive training about safeguarding people from abuse. This is to make sure they know what to do so that people living at the home are protected from harm. 06/03/2009 3 29 18 New staff must not work in the home until a POVAfirst check has been received for them. This is to make sure they are suitable to work with the 12/03/2009 Care Homes for Older People Page 24 of 27 people who live at the home and that people are protected from possible poor practice or abuse. 4 33 26 Where the registered person 12/03/2009 is an individual, he must visit the care home at least once a month to: interview service users and their representatives and persons working in the home; inspect the premises, its record of events and records of any complaints; and prepare a written report on the conduct of the care home. The registered provider must supply a copy of the report to the Commission and to the manager. This is to ensure that the home is being run in the best interests of the people who live there. 5 38 23 The registered person must, 27/03/2009 after consultation with the fire authority, take adequate precautions against the risk of fire. This is to make sure that people living at the home are protected from the risk of fire. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 27 1 16 Action should be taken to make sure that residents and their visitors know about the homes complaints procedure and have details about who to contact with any concerns or complaints. Fit over-rideable locks to toilet and bathroom doors so that people can have privacy. Review the accident reports on a regular basis, so that the information contained in the accident reports can be used to show whether any action might be taken to reduce the number of accidents occurring. 2 3 24 38 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
