Inspection on 10/05/06 for Thorntree Farm Nursing Home

This inspection was carried out on 10th May 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Thorntree Farm Nursing Home 12/06/07

Thorntree Farm Nursing Home 14/02/06

Thorntree Farm Nursing Home 15/08/05

Thorntree Farm Nursing Home 16/02/05

Thorntree Farm Nursing Home 10/08/04

Thorntree Farm Nursing Home 24/02/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

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

CARE HOME ADULTS 18-65 Thorntree Farm Nursing Home Low Lane Clayton Bradford West Yorkshire BD14 6QA Lead Inspector Sue Dunn Key Unannounced Inspection 10th May 2006 09:30 Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 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 Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 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 Adults 18-65. 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. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Thorntree Farm Nursing Home Address Low Lane Clayton Bradford West Yorkshire BD14 6QA 01274 817523 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Sikandar Divan Mrs Sheila Divan Mr Sikandar Divan Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20) of places Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2006 Brief Description of the Service: Thorntree Farm provides nursing care and accommodation for up to 20 people of mixed ages with a mental health illness. Most are physically active and can self- care, with prompting and support, and all are mobile. There were 16 people accommodated at the time of the inspection. The home, which is in a rural setting, is a two storey converted farm which has been extended. The closest amenities are in the nearby villages of Clayton and Thornton. Accommodation is on several levels and there is no lift. Four bedrooms are shared, the remaining are single. 6 of the rooms have en suite facilities. There is a good range of communal space throughout the home. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the inspection was to ensure the home was operating and being managed for the benefit and well being of the residents, all of whom have a mental health illness. Two inspectors undertook the inspection, which was unannounced. One inspector arrived at 9.30am the other at 10.45 and the inspection finished at 6.40pm. A pre inspection questionnaire asking the manager to provided up to date information has been completed since the inspection visit and returned. Comment cards with pre paid envelopes were left in the home inviting people to express their views about the service. None had been returned at the time of writing. The report is based on information received from the home since the last inspection in December, an additional visit in March, observation and conversation with residents and staff, discussion with the managers/proprietors, examination of 4 care files (which included case tracking two) and an inspection of the premises. This included an inspection of some bedrooms, all communal areas, and an overview of the grounds. Some of the service users are elderly having moved into the home from long stay wards when Scaleboro Park Hospital closed. The majority are under 65,and are more active service users who need a structured environment and support, to help them to manage their lives. The Managers and staff have to strike a satisfactory balance between directing and encouraging people who, because of their illness, lack motivation. The questionnaire from the home stated the monthly fee as between £474£533 and said this was ‘under discussion’. However the inspectors were given the figure of £506 and the figure on a contract seen was different again. All service users on assisted funding receive a weekly personal allowance. This has to cover personal toiletries, hairdressing, clothing, outings and personal spending. Some receive disability and /or a mobility allowance, which goes towards any transport costs. The quality outcome for the service is adequate. Outcomes could be good if the matters discussed during the inspection visit and identified in the report are addressed. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? The manager of the home has started to carry out her own assessments of needs before admitting people to the home rather than simply relying on those undertaken by other professionals. The relationships between the proprietors and other professionals was said to have improved with both sides making efforts to work together. The service users were appreciative of the efforts made by one night worker to add variety and interest to their evenings by bringing videos for them to watch. Some redecoration work has been completed and a new hand dryer installed in the upstairs bathroom. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 7 What they could do better: There was no evidence to show that staff had explained to new service users and social workers the structured way in which the home is run to ensure that people were aware that there may be restrictions to freedom of choice. All documentation was not signed, dated or accurate. This included contracts of occupancy and all documentation completed by trained nursing staff. The requirement to update of information in contracts of terms and conditions of occupancy was outstanding from the last inspection. Any restrictions of choice were not recorded in the care plans with reasons why and by whom such restrictions have been agreed. All care files did not show evidence of assessments of risk for falls, tissue viability, nutrition and any other physical or mental health care monitoring, with a clear plan of how any identified risks were to be kept to a minimum. Staff were not given guidance about how to work with individuals who resist their agreed programme of care. There should be evidence of a more imaginative range of menu options for people at mealtimes with hot and cold alternatives. Staff did not appear to be sensitive and flexible to changes in the health and abilities of service users. If for any reason there is a decline in mobility or physical well being they should adapt the level of support they give. Nursing staff in the home were not following current practices and working in accordance with the standards set by the Nursing and Midwifery Council. Some documentation by nurses was not legible, signed or dated and correction fluid had been used. There was not sufficient recorded information to show the level of supervision and care given to service users at night. Nursing staff needed training in care planning and reviewing care plans and in ensuring that service users were involved in this process. Some of the furniture in the main part of the house showing signs of wear and tear did not include a range of styles which took account of the different needs, shapes and sizes of the people who lived in the home. Some pieces of furniture were unstable. Some of the windows were poorly insulated causing them to mist up or allow heat loss. Some hazards identified within the building did not have written risk assessments to show why risks had been assessed as low, as discussed. The uncovered radiators were one example of this. The CSCI had not been notified of events, which may affect the well being of residents. Failure to do so is a breach of regulation. The records of money spent on behalf of service users was not clear, consistent and did not provide evidence in the form of receipts to show how money had been spent. A service user had been charged for maintenance and repairs with no evidence that this had been agreed as part of their care plan or funded contract. The manager /proprietors had difficulty accepting the points of view of other people and in accordance with their professional status without becoming angry. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in the outcome for service users is adequate. This judgement has been made for the following reasons:The admission process has improved with the introduction of the home’s own assessments to determine if they can meet needs and compatibility with existing service users. Information providing details about the facilities, services and ethos of the home is given to prospective service users and their representatives. This relies on people having the motivation to read the information therefore there should be evidence to show that the information has also been discussed and explained to service users. However, the details in the contracts of terms and conditions between the home and the service users were inaccurate and misleading therefore the quality outcome for service users in this area is poor. This is outstanding from the last inspection. EVIDENCE: One person whose care file was inspected had been appropriately admitted following an assessment by a Community psychiatric social worker and an in depth and informative pre-admission assessment by the manager. The managers of the home are careful to ensure they can meet the needs of each new resident without this having a disruptive effect on the people already living in the home. The home previously relied on assessments of need by Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 11 other health professionals, which did not always give them the information they needed to make a judgement. The managers stated they have difficulty obtaining information from health service staff relevant for the ongoing care they are expected to provide on grounds of confidentiality. Another file examined showed an assessment had been done at the time of admission. This was said to have been an emergency admission, though it had not been made clear in the written notes by the nurse who carried out the assessment. A service user spoken with on a recent additional visit by the inspector said she had visited the home and been given information about the home but had not read it, therefore was not aware of what to expect. Other residents spoken to had lived at the home for many years and were not sure if they had a trial visit. Another person could not make a contribution, or appropriate responses to questions asked. The inspector was informed that the home was expecting a social worker to bring a prospective resident to visit the home later in the day. The visit was postponed due to an X-ray appointment. A copy of the contract of residency seen in one file was signed by the next of kin, and stated the room to be occupied, however the contract contained no information regarding residents having to pay for any damage they cause. There was a discrepancy in one contract between the weekly and monthly fees and in the amount stated in the questionnaire which had been completed by the proprietors. The information in contracts must be accurate and up to date and show evidence that people have been informed when the fees change. This is outstanding from the last inspection. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Quality in the outcome for service users is adequate. This judgement has been made for the following reasons:Service users were satisfied that their health and social care needs were met and felt comfortable with the familiar routines. Care plans have now been written which provide some guidance for staff to follow but this needs further detail. The information relating to falls, tissue viability, nutritional assessments and blood sugar monitoring was inadequate in some files. The small, stable staff group had an understanding of personal preferences and routines based on familiarity. Basic personal care was good. Practical support varied according to the level of need. However, care plans were not being reviewed, amended and documented to show the guidance given to staff as needs changed. Evidence of the reasons and level of limitation on choice due to people being cared for under the Mental Health Act was not clearly documented in the care files. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 13 EVIDENCE: The files inspected for recent admissions showed all personal information had been documented and base line observations recorded. There was evidence of weight being recorded monthly for the first 6 months then two monthly as weight stabilised. The care plan documentation reflected the pre admission assessment. In one file there was an assessment of needs and evidence of multidisciplinary reviews, but none of the supporting care plans contained evidence of either resident or relative involvement. One person was on leave of absence to the home under the mental health act. There was no evidence of this seen in the care file. The outcome of an appeals tribunal had not been followed by an amended plan of care. One gentleman said he did not understand about care planning. Risk assessments had been documented in one file and where a risk was identified, any action taken to minimise the risk was documented. The risk/hazard assessment had not been completed in another file though during discussions with the managers and staff it was apparent that there were risks related to the person going out unaccompanied and in relation to certain other residents. A risk assessment for smoking arrangements had been agreed with one resident and relative and signed. Service users who smoked were seen to use the designated smoking area. It was apparent that agreements had been reached with some people to ration their cigarettes according to their budget so that they would last through the week. This was not recorded in the care plans. There was no evidence of routine nutritional screening on admission as is required though weight charts were seen in each of the files. The same file gave no evidence that the following risk assessments had been carried out: - Tissue viability, falls risk assessment. One service user said she was not interested in being involved in planning her care. She was quite happy for the staff to plan her care for her, and trusts the staff to care for her needs. She said she always speaks to one particular female day staff member if she has any concerns. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 The quality in the outcome for service users is good. Standard 16 regarding rights and responsibilities is adequate.This judgement has been made for the following reasons:The structured routine programme of weekly activities inside and outside the home, includes household chores, and provides a routine for people who have limited self-motivation. The service users who have lived in the home for many years and prior to that in long stay institutions enjoy the familiarity and security of the routine. Care plans did not show evidence that staff explain and make clear the reasons for any restrictions on choice. There was no evidence of the goals set for each person’s placement to show what different outcomes were to be achieved from the programme of activities. The menu is rather unimaginative but includes a balanced diet and suits the tastes, abilities and lifestyle of the present group of service users. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 15 EVIDENCE: Residents spoken to talked about the weekly activities. Most of the people at home were walking to the nearby village of Clayton to play bingo. (This supplements the income for those who win). Staff transport the less mobile. One person had a painful knee and said the walk was difficult. This was discussed with the manager. There is an expectation for more physically able people to assist with household tasks such as peeling potatoes, washing up, cleaning their own rooms, helping with their own laundry and assisting with the shopping. This aims to retain skills, which may otherwise be lost. Some of the residents spoke of going to the Richard Dunn stadium where they can play cricket, table tennis or swim or just watch. A community transport bus is used each week to take older people, and anyone else who wishes to go, out for a drive and a cup of tea One service user said the residents at the home have to pay for all their outings and entertainment but she didn’t mind. A small group regularly organise trips to the coast or other places for three to four people. Another resident said there is no pressure put on people to socialise. Activities are the same each week, so people know what is on offer. The same service user said she enjoys watching videos brought in by one of the night staff, who brings a good range to choose from. (A professional health worker felt that there was monotony about the programme of activities, which prevented people having new experiences. The manager said they struggle to get people to make suggestions about what they would like to do). Complaints in the past, raised by two people new to the home were about feeling pressured to do activities against their will. A recent admission to the home under the Mental Health Act was not made aware of the ethos of the home or the restriction of the placement, and was less satisfied with the directive approach. This is an area where the home has to strike a balance between being directive and giving choice and must provide evidence in the care plans that goals have been agreed with each service user. Several service users go each week to a large local supermarket to help with the shopping and some visit the hairdresser at the same time. More active service users do voluntary work in charity shops, attend college courses and one person was sweeping the driveway when the first inspector arrived. The Statement of Purpose informs visitors that they are welcome at any time. However, a visitor spoken with said that restrictions had been placed on his hours of visiting. The manager explained the reason for this but it was not recorded in the care plan. Residents spoken to said they could see their visitors either in the lounge or in the privacy of their rooms and that they were not aware of any restrictions. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 16 A relative spoken with said that the family have always felt comfortable when visiting. One lady said she received her private allowance and could spend it how she liked. Service users said they did not have the choice of a cooked breakfast. One person said the only thing that was hot at breakfast time was porridge, and that she would like to have the occasional bacon sandwich. The lunchtime meal prepared by staff (which was not observed) consisted of various hot and cold sandwiches, chosen by the service users who were at home, followed by fresh fruit and a drink. Those people who needed assistance ate in the dining kitchen. Some of the service users take turns to prepare the potatoes and vegetables for the evening meal. The main meal of the day is at teatime, around 4.30pm, when there is a cooked meal provided for the residents who live in the main house. The service users who live in the “cottage” take turns to make their meals. The evening meal prepared by one of them on the day of the inspection was turkey, potatoes and frozen mixed vegetables. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 19 Quality in the outcome for service users is adequate. This judgement has been made for the following reasons:Personal care was of a satisfactory standard with staff providing varying levels of support and prompting according to need. Written care plans had improved. They provided instructions for staff to follow but needed to show that the care plan had been discussed with the person concerned. (There was some evidence of this in the daily care notes.) The reviews of the care plans indicates some nurses are not aware of the purpose of the care plans and do not understand the process of reviews. Some nursing staff had not followed the NMC (Nursing and Midwifery Council) professional standards on recording information. Service users were satisfied by the care they received but the care provided was not supported by satisfactory documentation therefore can only be judged as adequate. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 18 EVIDENCE: There was evidence in the files of health care i.e. dental, optical and chiropody treatment. In one of the care files tracked there was a diagnosis of Diabetes Mellitus but there was no record of any arrangements for blood glucose level screening or regular urine checks to rule out the presence of sugar. One lady said that if she is ever ill, an appointment is always made for her to visit the GP surgery accompanied by staff when necessary, and that she is happy for staff to handle her medication. Other service users spoke of monthly appointments for blood checks as part of the monitoring of their medication. The nurse on duty administers medication. None of the service users manage their own medication. The consultant psychiatrist said that he is contacted if people are unhappy with their medication. Most of the people in the home have the continued support of CPN’s (Community psychiatric nurses) and psychiatrists. It was acknowledged by some of the health professionals spoken with that it is difficult to motivate people with mental health problems and the staff ‘do well to ensure people do not spend their days sitting in chairs’. The standard of personal care was high. Service users were observed to be appropriately dressed with attention paid to hair and fingernails and dental hygiene. Everyone was clean and there were no unpleasant body odours. Toileting programmes were being used for some people and the local health centre provided continence products. There was nothing in the daily notes or reviews to show the effectiveness of continence management programmes was being monitored. Daily progress reports were very detailed, however, there were gaps between some nursing entries and correction fluid had been used. This is not good practice as it leaves the opportunity for additional information to be added retrospectively. The signatures of some staff were illegible, and in some cases initials instead of full signatures were used. No entries had been made during the night on many occasions. This is not good practice as there was no evidence to support the level of supervision of residents at night. Gaps had been left between some of the entries in the daily records. The information recorded by the proprietors in the daily records was concise and informative. (The manager should refer to NMC (Nursing and Midwifery Council) advisory documents on record keeping, ensuring nurses are meeting professional standards.) Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The quality in the outcome for service users is adequate. This judgement has been made for the following reasons:Service users were satisfied that their complaints were listened to and where possible action taken. Overall, service users are protected from abuse with the majority of staff having an understanding of adult protection. Complaints about the regime of the home arose because people had not been clear about their plan of care or the terms of their placement. EVIDENCE: One lady resident spoken to said she has never had cause to complain about anything except for once which was a long time ago, and was concerning a missing item of clothing, which was found and returned. She said she does not think there would be any reprisals, and that she always talks to one particular member of staff if she has any concerns, as she trusts her. Three other service users spoken with said they did not have any concerns about discussing anything they were unhappy about. An investigation into a complaint since the last inspection, which was referred to adult protection, concerned the following: Staff exerting undue pressure and causing bruising, Unsuitable diet Inadequate heating and bathrooms cold as windows left open Doors closing too quickly No toilet rolls in the bathrooms Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 20 Medication being withheld. The part of the complaint concerning the toilet rolls was partially upheld the other elements were not upheld. The investigation showed that the home responded to complaints raised by service users or their representatives and tried to provide a satisfactory outcome. However the staff should have looked at the impact of their actions on all residents when dealing with needs of one person. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 and 30 The quality in outcome for service users is adequate. This judgement has been made for the following reasons:Some work on the environment has taken place after discussions on previous inspections, but further refurbishment and work is required to reduce the hazards and security issues identified and ensure the facilities meet the needs of the people living in the home. Any health and safety judgements must be supported by evidence of a risk assessment. EVIDENCE: All but one of the chairs in the main lounge (the one with an automatic riser) were the same height, which didn’t take account of the varying heights of people who live in the home. One service user’s feet did not touch the floor when seated. Though comfortable, some of the furniture was showing signs of wear and tear. Consideration should be given to a programme of replacement, which can accommodate the different needs of people living in the home. Some of the windows had misted over where the double-glazing seals had failed. It is understood that this work is to be carried out. During an additional visit to the home it was noted that the bedroom windows were poorly insulated reducing the effectiveness of the heating in the bedrooms. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 22 The gardener arrived to cut the grass during the visit. The inspectors pointed out that the flagged pathway at the rear of the building needed to be kept free of weeds, as it could be a slip hazard in wet weather. The inspector new to the home raised concerns about the doorway from the dining room, which leads onto a flight of steps to the games room at a lower level. A small step immediately as the door opens is a potential safety hazard as there is no warning sign alerting people that the step is there. The games room (formerly a cellar) has a low vaulted ceiling. There is no hazard warning sign. There was no nurse call system seen in this area. People who are judged as able to live with less staff support occupy the ‘cottage’. The lounge in the cottage, a light pleasant room, has a large patio door. The door did not appear very secure and during conversation with the proprietors the inspectors were told that two pictures had recently been stolen from the walls in this area. The proprietors did not know how the thieves had gained entry and had not notified the CSCI of this incident as required by the regulations. A coffee table in the room was unsteady and needed repairing or replacing. Radiators in the cottage did not have guaranteed low temperature surfaces or safety guards. A freestanding radiator in this area provided additional supplementary heating. The proprietor said he did not consider the radiators needed covers, as, in his view, the risk was low. There was no evidence of any risk assessment to underpin this judgement. There is also no nurse call facility in the lounge. An alarm bell in the hallway can be heard in the office. This is considered a satisfactory arrangement for the more able people who live in the cottage. The hand-washing provision in the bathroom (a bar of soap and a terry towel) could compromise the control of infection in the home. The nurse call lead over the bath was tied up out of reach. This must be accessible at all times. The bathroom in the main building had been redecorated since the last inspection. The proprietors have been asked to find a more satisfactory solution to the present one of giving each resident their own toilet roll and towel to keep in the bedroom to avoid these being put down the toilets by one person in the home and have provided an additional hand drying machine in the first floor bathroom. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 36 Quality in the outcome for service users is judged to be adequate. This judgement has been made for the following reasons:The home provides training opportunities for the care staff who have worked in the home for many years, have good knowledge of each service user and provide good basic care. However, staff follow regular routines and there was no evidence to show they are encouraged to question their practices and review the way they work and adapt to the needs of individual service users. Some nurses were not recording information as required by their professional code of practice and did not understand the purpose and review of care plans. The nursing staff must have supervision, support and further training to keep abreast of current practice. The service users had a good relationship with staff. EVIDENCE: There appeared to be sufficient staff on duty at the time of the inspection to meet the needs of the residents. Mr and Mrs Divan, both registered mental health nurses, were on the premises throughout the inspection and during the feedback session. The manager agreed that the quality of recording in the care files seen indicated that some of the trained nurses need to update their knowledge if they are to maintain the standards required of their profession. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 24 A care assistant who had worked at the home for 17yrs said she had received regular fire safety and manual handling training. That she had completed and achieved NVQ at level two, facilitated by Park Lane College, and that she was interested in doing level three. She also said she had received training in basic food hygiene. The home provides a placement for student nurses who have, in the past, spoken well of the support and information they received from the proprietors. The recruitment and selection records were not inspected during this visit, as there have been no changes in the staff team since the last inspection. Staff are responsible for supporting service users with a wide range of abilities. Some service users need help with all their care needs, others simply need emotional support and prompting. One person said she didn’t feel she got much help with daily tasks but two others said they found staff prepared to help and encourage them when needed. There was a good relationship observed between service users and staff, who went about their duties in a calm and unhurried way. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 and 42 The quality in the outcome for service users is adequate. This judgement has been made for the following reasons:The homes proprietors/managers have appropriate qualifications and many years of experience of working with people with mental health illnesses. They provide a very structured routine aimed at providing a stable lifestyle for people who have little self- motivation. Most of the people who live in the home and their relatives are satisfied with the service they receive but there are no systems in place to enable them to make a contribution to the service should they wish to do so. The managers and staff are quite isolated and do not have systems in place to examine and audit their own practices in order to continue to develop the service. The records of finances managed on behalf of service users were not of a standard to allow for ease of audit by inspectors or interested relatives. Care planning and the quality of nursing records was patchy and not in accordance with professional nursing standards. There were concerns about some health and safety issues within the building. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 26 EVIDENCE: The proprietors, who have many years of experience working with people with mental health illnesses, provide hands on care in the home. A relative spoken with said ‘they do a good job with people who are very difficult to care for and are always helpful and prepared to listen’. He said the family have peace of mind knowing their relative is fed, clean and cared for. There has been an improvement in the pre admission assessments, care plans and personal risk assessments but the quality and consistency of record keeping was patchy. This was good in some files but there were gaps in documentation in others and areas where correction fluid had been used to cover errors. The proprietors could not show evidence of risk assessments to underpin their judgements in regard to the remaining unguarded radiators, tissue viability, nutrition or falls. There was a disappointing and heated response from the proprietors to advice on best practice, and explanations giving the reason why they were being asked for certain action to be taken. This raised some concerns about the style of management. A selection of residents’ financial records was reviewed. Records provided for the person managing one service user’s finances were seen and appeared appropriate. All other financial records seen were disorganised, inconsistent, did not follow a format and could not be tracked. One of the proprietors refused to accept that the records showing how service user’s finances were managed were unsatisfactory. The other proprietor however understood the reason why the records of finances had to be understandable and took advice from the lead inspector how best to do this. It was of concern to note that one service user (whose behaviours lead to unsuitable items being put down the toilets), had been charged for unblocking the drains, on the basis that the terms and conditions state that the home may charge for damage. This is unacceptable and the proprietors were advised that if the home could not meet this resident’s needs in terms of his behaviour, they should take steps to arrange a re- assessment to determine if the resident was appropriately placed at Thorntree Farm. Evidence was produced to show that all portable electrical appliances were last tested in August 2005. There was a satisfactory report following an environmental health inspection of the kitchen in November 05. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 x 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 x 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 x x 3 2 2 x 2 2 x Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 28 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 YA5 Regulation 5 Requirement Timescale for action 31/08/06 2. YA6 All residents must have an up to date accurate contract which includes all the information required by the regulations This is outstanding from the last inspection 15,17(schedule Care plans must be 3) reviewed to reflect the goals and outcomes agreed with each resident and show any restrictions on choice and the reason for that restriction. 13,15 31/08/06 3 YA8 4 YA8 5 YA9 Any decisions which affect 31/08/06 the rights of service users must be recorded as part of their care plan 12, 13, 15 Staff must ensure service 31/08/06 users are consulted and adapt their approach to changing health needs and circumstances Regs 12 13 14, There must be evidence to 31/08/06 15,17 show that people with diabetes are monitored and the following checks are carried out for everyone, with evidence DS0000019903.V292224.R01.S.doc Version 5.1 Page 29 Thorntree Farm Nursing Home that they are routinely reviewed and an action plan is in place where areas of risk are identified: Nutrition Tissue viability Falls 6 YA19YA18YA8, 14,15,17 Records must be of a satisfactory standard, accurate, legible, signed and dated The manager must give notice to the commission any event in the home which adversely affects the well being or safety of any service user The premises must be safe and well maintained as follows: The windows to be suitably insulated. Warning signs placed at the top of the stairs and to alert people to the low ceiling in the games room. Repairs to the patio door in the cottage to ensure it is secure. Risk assessments for all the uncovered radiators. All unsteady furniture to be removed The nurse call system in the bathroom must be accessible at all times. Suitable hand drying facilities must be provided in the bathroom of the cottage to reduce the risk of cross infection Nursing staff must adhere to the standards of conduct and practice DS0000019903.V292224.R01.S.doc 31/08/06 7. YA19 37 30/07/06 8 YA24 13, 23 31/12/06 9. YA30 23 31/08/06 10 YA31 17, 18 31/07/06 Thorntree Farm Nursing Home Version 5.1 Page 30 11 YA37 10,18 12 13 YA38 YA39 10, 17 24 established by their regulatory bodies The manager must 30/09/06 provide a satisfactory level of supervision for support and monitoring of staff practices in the home The processes of 31/08/06 managing the home must be open and transparent The home must have 31/12/06 effective quality assurance and quality monitoring systems 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. Refer to Standard YA17 YA24 Good Practice Recommendations The menu should be reviewed periodically and include hot and cold choices. As furniture is replaced a variety of furniture should be provided to accommodate the different sizes of service users. Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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. Extracts may not be used or reproduced without the express permission of CSCI Thorntree Farm Nursing Home DS0000019903.V292224.R01.S.doc Version 5.1 Page 32 - 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. 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