Inspection on 10/02/09 for Thornwood Care Ltd

This inspection was carried out on 10th February 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Thornwood Care Ltd Turkey Road Bexhill On Sea East sussex TN39 5HZ     The quality rating for this care home is:   two star good 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: Deborah Calveley     Date: 1 0 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 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (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.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Thornwood Care Ltd Turkey Road Bexhill On Sea East sussex TN39 5HZ 01424223442 01424223442 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): THORNWOOD CARE LTD Name of registered manager (if applicable) Mrs Indra Hughes Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 16. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Date of last inspection Brief description of the care home Thornwood Care Home provides care for up to 16 older people with a dementia type illness requiring personal care and support. The home offers single personal accommodation on two floors with a kitchenette, lounge and dining room on each floor. The home is situated in a quiet residential area in Sidley village, approximately five miles from Bexhill town centre. There are local amenities close by and public transport run regularly. There is a good sized passenger lift that provides level access to all areas of the home. There are communal bathrooms and toilets with specialist equipment for those that are physically frail. Other facilities include a variety of sitting rooms, a large communal day Care Homes for Older People Page 4 of 26 care home 16 Over 65 0 16 Brief description of the care home room and wide corridors with extra seating. All bedrooms are connected to the call alarm system, have cable TV and are fitted with telephone points. It is a spacious home that is fit for its purpose and well maintained. Redecoration is on going and there are plans for updating the communal areas. The home is set in attractive grounds and provides off road parking for visitors. There is an attractive sheltered garden area with seating that is both secure and peaceful. Care Homes for Older People Page 5 of 26 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: two star good 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings For the purpose of this report those living at Thornwood Care home will be referred to as residents This was the homes first key inspection that included an unannounced visit to the home and follow up contact with two health social care professionals who have had some recent involvement with the home The allocated inspector spent approximately five hours in the home and was able to discuss the home and the inspection process with the registered manager who received the inspection feedback at the conclusion of the visit Care Homes for Older People Page 6 of 26 During the assessment visits the inspector spent time meeting with residents staff and observing practice in the home. A tour of the premises was undertaken and a range of documentation was reviewed including the homes statement of purpose pre admission assessment procedures the systems in place for handling complaints and protecting residents from harm staff recruitment files quality assurance systems and some health and safety records The care documentation pertaining to three residents were reviewed in depth and the inspector observed the midday meal in the small dining area A visiting professional said the care in the home is good and there are no negative comments. This inspection has been completed with a proportionate approach and it must be bourn in mind that this is a new service that is operating at approximately a third of its full occupancy. The home has therefore been judged on its current provision service and management arrangements. Fees currently range from 426 00 pounds to 500 00 pounds per week. Additional charges are made for individual newspapers, chiropody, hairdressing and physiotherapy. What the care home does well: What has improved since the last inspection? What they could do better: 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 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 9 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home its facilities services and the costs involved. The admission procedures ensure that all prospective residents are fully assessed by a competent person before admission and are assured in writing that their needs can be met by the home. Evidence: The homes Statement of Purpose and Service Users Guide was available on request and includes photographs of the home and grounds. These documents were informative and contained information on fees and any additional costs. The Service Users Guide states that the home enables older people from multi cultural and socially diverse areas to continue living as independently as possible by receiving care and support consistent with their capacities and disabilities. Care Homes for Older People Page 10 of 26 Evidence: An assessment of the admission process followed included the review of the documentation relating to all three admissions to the home. This confirmed that all prospective residents are assessed by the registered manager and take into account individuals needs and what the home can offer. The manager has a clear understanding of the homes admission criteria and explains this to prospective residents and their representatives. They are therefore aware that any changing needs are subject to constant reassessment that may lead to relocation to another more suitable care home. The registered manager confirms in writing that the prospective residents needs can be met by the staff and facilities at Thornwood. Intermediate care is not provided at Thornwood Care Home. Care Homes for Older People Page 11 of 26 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. Whilst residents needs are being met and individual plans of care are devised, these did not take into account all relevant risks. On the whole the homes practice ensure residents medicines are administered safely and care is delivered in such a way that promotes and protects the residents privacy dignity and individuality. Evidence: Three individual plans of care were reviewed in depth as part of the inspection process. The care plans were in the main well developed and reflected individual preferences and choices. Discussion took place with the manager regarding the benefit of using assessment tools for health needs (Nutrition, moving and handling and tissue viability) on admission to provide a baseline from which staff can monitor their health and therefore seek specialist help early. Although risk assessments are used in some areas, they are not being used in a systematic way to inform the care and need to be appropriate to the risk being assessed. Daily records are maintained and these Care Homes for Older People Page 12 of 26 Evidence: reported clearly on peoples activity, health needs and the care provided as well as the regular contact with the GPs and community nursing services. There was also evidence that the plans of care are being reviewed and updated regularly. The manager is keen to promote a person centred approach to care that is inclusive of residents views and agreement and the involvement of their families and friends. Observation in the home confirmed that staff were meeting residents needs in a flexible way allowing residents as far as possible to direct the care and support that they need. The clinical room is large with plenty of storage space. The pharmacy provider has provided the home with a trolley controlled drug cupboard and fridge. Staff specimen signatures need to be in place for the purpose of audits and monitoring staff practice. Practice seen during the inspection visit confirmed that medicines are administered in a safe way by those members of staff who have been trained to do so. A review of the Medication Administration Recording (MAR) charts confirmed accurate and clear record keeping. To ensure the staff understand the residents medication, including the contra indications and side effects these need to be included in the individual care plans and also include clear criteria for as required medication and analgesia. From direct observation it was evidenced that staff were both kind and attentive and always appropriate in their approach. Residents clearly liked the staff and manager of the home and interaction was seen to be positive. Care Homes for Older People Page 13 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to live their life in accordance with their own expectations and preferences maintaining strong links with family and friends. Residents choices are well respected and the food provided is both appetising and wholesome and served in a comfortable environment. Evidence: There are no set routines in the home and this allows the care and services to be flexible. An activities co-coordinator has recently been recruited and will be organising activities for all three homes that are owned by the organisation in the near future. With only three residents in the home the activities at present are mainly one to one sessions. The residents currently living in the home enjoy walking and the homes wide corridors and spacious communal areas are ideal for this. The home also has a large communal day room with doors leading out into a courtyard and garden area, once occupancy increases this area will be utilised more positively. the residents currently use the smaller lounge areas. Further small seating areas are available in the large entrance area and first floor landing. Care Homes for Older People Page 14 of 26 Evidence: The home has an open visiting policy and all visitors are warmly welcomed. Residents rooms are seen as their own private accommodation and staff always knock on doors and wait for a reply before entering. None of the residents living in the home deal with their own financial affairs and they are all supported by either a relative or a representative. All residents are enabled as to be involved as much as possible regarding control over their lives making decisions and maintaining their own autonomy. The registered manager works well with residents and staff to ensure that this freedom and protection of individuals rights is maintained. There is a large kitchen that is well equipped but not in use at this time as there are only three residents living in the home. However it is fitted out and ready for use. When the residency figures improve the home will employ a cook, at present the cooking is undertaken by the staff on duty. It was discussed the importance of ensuring that all staff that handle food in the home receive training in food hygiene. The residents enjoyed their lunch and staff confirmed that alternatives are available. The menus were viewed and demonstrated a wholesome and varied diet. The manager has devised a picture menu to enable residents to choose their meal. It was clear that every effort is made to ensure the food caters to individual choice and ensure residents satisfaction. The dining room in use at this time was comfortable and homely and is part of the lounge area on the ground floor. Care Homes for Older People Page 15 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that any complaint would be listened to and responded to appropriately. Staff awareness and information in the home ensures that any Safeguarding Vulnerable Adult issue would be responded to appropriately when identified. Evidence: There is a complaints procedure available in the home. A review of this documented identified that it was clear and uncomplicated however it would benefit the people who use the service if there was a picture format available. Everyone spoken to as part of the inspection process confirmed that they would feel comfortable in raising any concern with the registered manager and were sure that she would deal with any matter in an effective way. There have been no complaints received by the home and no safe guarding alerts raised. There is a Safeguarding Vulnerable Adults policy and procedure in place to guide staff in protecting their residents. There is evidence that staff receive training in safeguarding adults and this is updated regularly. Care Homes for Older People Page 16 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable clean and safe environment for those living in the home and visiting. Residents are enabled and encouraged to personalise their room and rooms are homely and reflect the residents personalities and interests. Evidence: Thornwood Care Home was initially purpose built for short stay intermediate care under the ownership of Social services. It is situated in a quiet residential area in Sidley village, approximately five miles from Bexhill town. There are local amenities close by and buses run regulary. It is a spacious home that is fit for its purpose and well maintained, its design is dated but the space and open design compensates for this. Redecoration is on going and there are plans for updating the communal areas. The whole environment is both attractive and appropriate to meet the needs of older people who need personal care and support. The home is set in grounds and provides off road parking. There is an attractive patio area with seating. There is scope for further garden facilities to promote the garden areas use. Residents accommodation is found on two floors and a passenger lift ensures that disabled access is provided throughout the home for the residents. Each of the residents private rooms are fitted furnished and decorated to a satisfactory Care Homes for Older People Page 17 of 26 Evidence: standard with TVs provided, nurse-call system, thermostatically controlled heating fitted storage and vanity units. The rooms are all virtually identical measuring 10 sq m including bay windows. This is now considered below the minimum size set for new registrations but the view taken in this instance, where private rooms are used mainly for sleeping that in all other respects the spaciousness of the communal areas at Thornwood provide a suitable environment for those suffering with confusion, whose needs include the freedom to wander safely with ease of access to all facilities. The home has no ensuite facilities but communal toilets are placed conveniently opposite bedrooms on both floors. There are adequate communal bathrooms in the home with specialist equipment which enables frail residents and those with a physical disability to enjoy the facilities available. Specialised equipment to encourage independence is provided e.g handrails in bathrooms, hoists, wheelchairs and lifts to all areas of the home. Call bells are provided in all areas. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. Random temperatures were taken and were of the recommended level. There are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. The records in the home confirmed they were up to date. The tour of the home confirmed that staff are aware of the fire safety policies, no doors were found inappropriately wedged open. All bedroom doors have electronic door guards. Polices and procedures for infection control are in place and it was confirmed that these are updated regularly. The home was clean and free from offensive odours on the day of the inspection. Although the home has sluice rooms these do not provide equipment that disinfects urinals, bedpans or commode pots effectively and safely. These facilities need to be reviewed to ensure suitable disinfection is taking place Care Homes for Older People Page 18 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers and skill mix provides a competent and well-motivated staff team that meets residents health and personal care needs. Residents are protected by the homes recruitment procedures. Evidence: At the time of this assessment visit, three permanent residents were residing at the home with another resident currently in hospital. The registered manager was working in the home with two carers. The managers hours are 9 am until 5 pm Monday to Friday. With the current low occupancy and dependency of residents the staffing arrangements allow for two carers throughout the waking day with one carer at night. The manager confirmed that the staffing is under constant review to ensure suitable staff to meet the needs of residents. There needs to be a lone worker policy and procedure in place along with an on call rota to support the carer at night. Duty rotas are available and confirmed that the staffing ratios are maintained throughout the week. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the relevant information required. There was evidence of health questionnaires, Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. Care Homes for Older People Page 19 of 26 Evidence: The home manager has produced a staff handbook and this is issued to all staff along with a job description and employment contract. The induction programme is now in place and has been introduced for all staff. Files seen confirmed this. Staff spoken with said that training opportunities at the home are good and they are well supported by the senior staff and the manager. Staff and the training list seen confirmed that compulsory training such as manual handling adult protection first aid and fire safety are being undertaken. The staff at present are cooking and serving food and therefore need to receive appropriate training in food hygiene. 100 per cent of the staff currently working in the home have a National Vocational Qualification. Care Homes for Older People Page 20 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall management of this home is good with effective systems in place to protect residents. Evidence: The registered manager has the relevant experience of owning and managing two care homes since 1985. She is a dual registered state registered nurse and mental health nurse. She has completed the Registered Managers Award and has undertaken a post graduate course in Counselling Skills. She continues to update her practice by attending regular training. It was clear from contact with the residents and social health care professionals that the registered manager is well liked and respected. The manager confirmed that further staff are to be recruited and will include a deputy manager as occupancy increases. Care Homes for Older People Page 21 of 26 Evidence: The home has a variety of quality auditing systems and the registered manager will be sending out surveys in the near future. This will be used to confirm how services can be improved and developed and reported on accordingly. The home have monthly staff meeting which are recorded and residents and visitors are able to meet regularly with the manager and discuss any problems, this will be formalised as occupancy increases. The home does not take any responsibility for any of the residents finances and most residents have an allocated person to do so. A procedure in respect of holding and receiving money or valuables on behalf of residents is available in the home for staff to follow. The home has a comprehensive set of policies and procedures in place to guide staff and protect the residents. The records relating to hot water checks were seen and confirmed that these are maintained. Thornwood was registered six months ago with all safety checks being completed at this time. It was confirmed by talking to the staff and to the manager that staff receive regular formal supervision. The accident book was available for viewing and it was confirmed that there are first aid boxes in the home that are readily assessable for use. The manager confirmed that regular environmental risk assessments are in place, but could not be found when requested. The manager confirmed by telephone the next day that the risk assessments had been located. The risk assessments need to be available fo guide staff and protect the residents living in the home. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 23 of 26 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 8 14 That the Registered Person 20/04/2009 ensures that appropriate risk assessments are in place to cover all area of risk and responded to. These should cover medication and risks associated with nutrition and skin damage. To promote the health needs of the people who use the service. 2 9 13 That the registered person 20/04/2009 must ensure that staff specimen signatures are available. That risk assessments of service users medication are included in the individual care plans guiding staff to identify side effects and contra indications. To promote and protect the health of the people who use the service Care Homes for Older People Page 24 of 26 3 15 18 That the registered person 20/04/2009 ensures that all staff receive the appropriate food hygiene training necessary to allow them to cook and serve food. To ensure that service users are protected by trained staff. 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 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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. 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