CARE HOME ADULTS 18-65
Thorntree Farm Nursing Home Low Lane Clayton Bradford West Yorkshire BD14 6QA Lead Inspector
Sue Dunn Unannounced Inspection 14th February 2006 09:30 Thorntree Farm Nursing Home DS0000019903.V282453.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.V282453.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.V282453.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.V282453.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th August 2005 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.V282453.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report is based on an unannounced inspection carried out by one inspector over a period of 8.45 hours. The purpose of the inspection was to ensure the home was operating and being managed to a satisfactory standard and in the best interests of the residents. A selection of key standards was inspected and the progress on requirements and recommendations from the last inspection was assessed. Several residents were spoken with and others, who were reluctant to speak, were observed. What the service does well: What has improved since the last inspection?
A pre admission assessment was undertaken by the manager of the home prior to the admission of the last resident. Though information provided by the social work team was limited the home was able to establish a basic care plan for safety and security. Staff have had training on adult protection since the last inspection. One of the bedrooms had been refurbished and made into a pleasant single room with en suite facilities. The ground floor bathroom had been redecorated. Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 6 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. Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 7 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.V282453.R01.S.doc Version 5.1 Page 8 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): 2,5 EVIDENCE: A pre admission assessment had been undertaken by the manager of the home before the admission of the most recent resident. This gave a general overview of the current needs and aspirations of the prospective service user but did not state how the home would meet the needs. It is appreciated that as the social background information in the care referral was limited there was little on which to base more than a basic care plan covering safety and security. A signed contract was seen in one file. This stated the terms and conditions of occupancy but the name of the person, the room they were to occupy and the fee had not been completed therefore the form was not valid. It was agreed that all files would include a signed and fully completed contract before the next inspection. Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 9 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): 6,7,8,9,10 Residents care needs were met but this was not fully evidenced in the care plans. Care plans must identify long term goals, be reviewed at least monthly by the home and show evidence of discussion with the residents. The programmes and routines are designed to provide structure to the week and motivation for residents. EVIDENCE: Two care files were inspected. Each had a plan of care, which itemised the immediate aims of the care and the action to guide staff on how to support and motivate each resident to achieve their aims. The home provides a structured regime for each resident but only one plan had been reviewed (evaluated) after a period of three months to see if it was effective. Staff did not appear to understand the purpose of care plans or how to review them as the evaluation made no reference to the original care plan. New needs had been identified but there was no clear action plan to show how the needs were to be met. Without evidence that the care plan has been discussed with the residents, agreed and reviewed at least monthly to ensure it remains appropriate and effective lays the home open to allegations of abusing peoples rights.
Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 10 As the home describes its purpose as offering rehabilitation there must be evidence to show the long-term goals of residents. Written risk assessments had been included in the care files. These also require periodic review. The information regarding resident care is safely stored but available for staff to access as required. A student nurse stated she had been able to use the care plans for guidance but had relied more on observation of the way other staff worked. Residents are involved in routine domestic tasks, food preparation and shopping during the course of the week according to their abilities and are strongly encouraged to participate in the programme of activities inside and outside the home. Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 11 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): 11,12,13,14,17 The home provides a structured weekly routine and residents are encouraged to participate in social and leisure activities, and assist with domestic tasks. The long term aims of each person’s programme must be more apparent in the care plan. EVIDENCE: Residents spoke to the inspector about their organised programme and said they were satisfied with the weekly routines, which provided a balance of work leisure and exercise. The student nurse on placement felt that residents benefited from their involvement in domestic tasks. A younger service user attends college and several attend a weekly cookery class where they prepare a meal to bring home and share within the ‘cottage’. One person expressed an interest in learning cake decoration. The people in the cottage take turns making meals, which they eat together. Other able residents assist by preparing vegetables and laying the tables for staff who prepare the meals and assist frailer people to eat. Healthy eating is encouraged and fluids are made available during the day. The more independent residents organise outings to the coast, bus rides, visits to relatives and make use of community facilities such as the hairdresser, the supermarket cafeteria and to a local bingo session. There were some concerns about having to use the limited weekly allowance to pay for taxis from some of
Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 12 the activities though it was clear that the cost of this is usually shared. Some people receive mobility allowance. The home has a regular weekly booking for a mini bus which takes people to a sports and leisure centre on the outskirts of the city. People described the rules as ‘strict’ and gave an example of the TV not being turned on until 7pm unless there was a specific programme to watch, such as tennis. The general view was that there had to be some rules in a shared house. The manager stated this was not a hard and fast rule and in fact a TV film was on during the afternoon for older residents who stayed at home. Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 13 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): 18,19,20 The home is able to meet the health and personal care needs of service users. However, the care plan records need to improve to provide evidence that health care needs are identified and monitored. All staff must be made aware of Regulation 37 notifications EVIDENCE: Much of the personal care support in the home takes the form of prompts from staff. It was apparent from talking to some residents that they have the opportunity to discuss their medication needs with health professionals beyond the home. All but one person is registered at the local health centre. The pharmacy provides medication in pre dispensed dosset boxes. This is checked and safely stored. Residents go to the office for their medication where it is administered by nursing staff. Transport is provided to support residents to attend clinic appointments if required. Regular dental check ups are arranged. The CSCI had not received notification about an incident recorded in one person’s file, as the staff were not clear about what was a notifiable event. It is the registered manager’s responsibility to ensure the regulatory requirements are met.
Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 14 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): 22,23 Staff are made aware of the complaints procedure and their understanding gives assurance that complaints will be listened to and service users will be protected from abuse. EVIDENCE: A student nurse on placement at the home was aware of the homes complaints procedure. Residents said they felt able to express their views and felt they were listened to about matters concerning domestic arrangements but sometimes had to ‘stay firm’ to get a point across concerning decisions about their own lives. All but one of the staff has attended training on adult protection Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 15 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): 24,25,27,28,30 The home offers a clean, satisfactory, environment for the residents and provides a range of appropriate communal areas. Service users access to toilet and hand washing facilities must not be restricted because of the needs of one person in the home EVIDENCE: The home, which is a converted farmhouse, is domestic in appearance. It’s several different floor levels make it unsuitable for people with high physical care needs. Four of the bedrooms are shared. One previously shared room on the lower floor has been refurbished and become a single room with en suite facilities which offer more privacy for one of the service users. People have arranged their bedrooms to suit their own tastes and preferences. All bedrooms can be locked. Bathrooms and toilets are shared. Some decorative work has improved their appearance. It was noted that toilet areas did not have toilet rolls or hand drying towels. Residents explained that each person keeps their toilet roll and towel in their room as one person puts moveable items down the toilets blocking them. A solution must be found to ensure that people are able to wash and dry their hands without the risk of cross infection.
Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 16 It was noted that staff lock the toilet adjoining the lounge when it is not in use for the same reason as above. Access to this area must be made available to all the residents, not just those accompanied by a member of staff. Communal areas throughout the home were warm and comfortable though some of the dining furniture was well worn and uncomfortable. Residents commented that they appreciated the cleanliness of the home, the weekly bed changes and the standard of care of personal clothing. Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 17 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): 32,33,35 The numbers and skill mix of staff were sufficient to meet the needs of the service users. The home’s training programme keeps staff updated in the knowledge they need to carry out their role. Staff need training to understand the purpose and implementation of effective care planning. EVIDENCE: Two care workers, a student nurse and the nurse manager were on duty at the time of the inspection with 15 of the 16 residents at home. There had been no staff changes since the last inspection, the exception being a student nurse on placement. The student felt she had been given a good introduction to the home, which covered fire safety, policies and procedures and the needs of the residents. The ongoing support was described as good and she felt she had gained a lot from the placement. Three of the 7 care staff had achieved the NVQ award. Staff training, and training updates, included dementia, MRSA, diabetes, adult protection, anaphylaxis and drugs. Certificates of attendance stored in each staff file provide proof of training. This involves checking every file. It is recommended that the manager keep a separate record of training courses and dates for each member of staff for easy reference and update. It was apparent that staff needed training and support in developing, recording and reviewing care plans
Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 18 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): 37,38,42,43 The proprietors/managers continue to take an active part in the day-to-day decisions and management of the home. The ethos of the home is to provide care and rehabilitation. It was agreed that the nurses and staff need training to ensure the care plans involve the residents and focus on an outcome. A more proactive approach should be taken to monitoring health and safety and the general upkeep of the building. EVIDENCE: The proprietor/managers are trained registered mental nurses (RMN’s) and one is a registered social worker. They retain their registration through attending training courses relevant to their role. Both had attended a course on the safe administration of medication and the legal aspects of care, the day before the inspection. It is important that the line between their roles and responsibilities as nurse managers and that of other professionals is clearly defined as discussed. The managers aim to provide a structured programme of activities and tasks in which people are expected to take part according to age and ability. The purpose of the regime is to direct and motivate people to be active and take
Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 19 responsibility for their own lives. The present care plans do not give guidance on the goals agreed with each resident and are not effectively reviewed on a monthly basis and updated as necessary. Without this there is a risk that peoples’ rights may appear to be compromised and though satisfied with the programme, people slip into habitual routines, which do not focus on a rehabilitative outcome. It was encouraging to see that risk assessments covering a broader range of activities had been introduced. Records are kept of the weekly fire safety checks and the maintenance and repair of the building is carried out on an ad hoc basis as required. It is recommended that the home carry out a routine full health and safety check throughout the building to ensure details, which keep the environment up to standard, are not overlooked. Residents confirmed that they receive their personal allowance weekly. The manager explained that as this has to cover clothing and toiletries there is little money spare for people who smoke. Some people rely on staff to bring items of clothing. The proprietors were able to provide a form of business plan, which showed forward plans for training. This, as stated after the last inspection should be reviewed and developed further to provide evidence of forward planning to keep all parts of the building up to a satisfactory standard of furnishing and decor. Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 20 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 x 2 3 3 x 4 x 5 2 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 3 25 3 26 x 27 2 28 3 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 3 34 x 35 3 36 x 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 x 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 x x x 3 3 Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 21 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 YA5 Regulation 5 Requirement All residents must have a contract which includes all the information required by the regulations Care plans must be written and reviewed to reflect the goals and outcomes agreed with each resident and any restrictions 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 Action must be taken to ensure residents’ access to toilets and hand-washing facilities is not restricted to accommodate the needs of one person Hand washing and drying facilities must be provided in all toilets to reduce the risk of cross contamination Timescale for action 30/04/06 2 YA6 15,17 (schedule 3) 37 31/05/06 3 YA19 30/04/06 4 YA2727 23 30/04/06 5 YA30 23 30/04/06 Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 22 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 4 5 6 Refer to Standard YA2 YA35YA6, YA6 YA7 YA41 YA42 Good Practice Recommendations Pre admission assessments should state what the home would do to meet the needs of the prospective resident. All the staff in the home should receive training to understand the purpose and effective use of care plans Care plans should identify long term goals for rehabilitation Staff should make it clear that some of the home’s ’rules’ can be re negotiated according to circumstances. The records of staff training should be easy to access and check. The business plan should be reviewed before the next inspection to show more evidence of forward planning Thorntree Farm Nursing Home DS0000019903.V282453.R01.S.doc Version 5.1 Page 23 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
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