Inspection on 28/06/07 for Thorpedale

This inspection was carried out on 28th June 2007.

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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Thorpedale 07/06/06

Thorpedale 14/02/06

Thorpedale 09/08/05

Thorpedale 26/01/05

Thorpedale 03/08/04

Thorpedale 22/01/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Thorpedale 1 Station Approach Chorleywood Rickmansworth Hertfordshire WD3 5AJ Lead Inspector Marian Byrne Key Unannounced Inspection 28th June 2007 10:00 Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 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 Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 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. Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thorpedale Address 1 Station Approach Chorleywood Rickmansworth Hertfordshire WD3 5AJ 01923 284648 01923 284648 kseager@watfordmencap.org.uk 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) Watford and District Mencap Keith Philip Seager Care Home 7 Category(ies) of Learning disability over 65 years of age (7), registration, with number Physical disability over 65 years of age (7) of places Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2007 Brief Description of the Service: Thorpedale is a large, two storey, detached house that offers seven single occupancy bedrooms. One double bedroom has been divided to create two single bedrooms. Two of the single occupancy bedrooms are located on the ground floor. There is a kitchen, a lounge/dining room and a laundry that are also situated on the ground floor. The home is surrounded by gardens that have the potential to contain a variety of features such as a patio area, a vegetable patch and raised flowerbeds. There are a variety of shops within a short walking distance and an underground station providing links with central London. Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector over the early afternoon and evening. The Manger was present during the inspection. On the day of the inspection interviews for staff were being held at the home. No service users were involved in the interviews on this day. What the service does well: What has improved since the last inspection? What they could do better: Care plans still lack necessary information to describe how individual needs are met e.g. diabetes and challenging behaviour. These are vital in light of the arrival of new staff. Care plans should reflect the good standard of care delivered. One service user is being encouraged to lose weight and to better manage their diabetes it was not clear who takes responsibility for the monitoring of this service users medical condition i.e. diabetics. The role of the district nurse and staff is confused. This must be clarifies to ensure the health of this vulnerable service user is not compromised. The garden remains unkempt and difficult for service users to access. Maintenance is needed regarding décor and fittings e.g. door handles missing in the kitchen. It is appreciated that the doors are dummy doors however the units look unfinished and neglected. Used sharps were stored in a sharps bin; this bin was in a service user room. This is very dangerous as the service user in question leaves his door open and Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 Page 6 the other service users could have access to them. The management of the home is confused. Details on service users are kept in a number of places. It does not appear to have been collated and a definitive care plan drawn up. 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. The summary of this inspection report can be made available in other formats on request. Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 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 Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Assessments are in place for existing service users. A format is in place to assess any potential new service users. The manager reported that the company would review this in the near future. Members of the multi disciplinary team liaise with the home and provide additional information where required to form the foundation for care plans. Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are very confused and do not give access to good quality information in an easy to access format. Service users are assisted to live independent lives. EVIDENCE: As identified at earlier inspections, care plans are in place but do not contain adequate or specific information relating to service users’ individual needs. Staff on the day of the inspection provided a good standard of care. It is not evident how staff assists a service user to manage his diabetes. The inspector was offered no evidence on how the staff recognise the risks of diabetes, and how to manage them, or how diabetes is managed with appropriate nutrition. Staff would find it difficult to provide consistency of care without the benefit of a care plan that has collated all the information available and a definitive care plan is drawn up. The relationship between the staff and the District Nurse and roles and responsibilities are unclear. There is information in the home on diabetics but there was no evidence that staff had read and understood this. Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 Page 10 This must be included in the care plan. The information on service users is in too many different files there is no link between the files and staff would be unaware if they were accessing full information. Service users are encouraged to make choices and this was evident during the inspection regarding meal choices and choosing where to go out on an outing. Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lifestyle of the service users is good. EVIDENCE: Some service users attend day care and those who wish to retire and remain at home do so. The service users are familiar with the local community and take full advantage of local facilities. One service user attends church and has partakes of the social side of church life. The home has a minibus but this is on loan during the day on weekdays. It is again recommended that this practise be reviewed to enable service users to have more regular access to the mini bus should they require it. Service users participate in planning meals and shopping for food. Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and personal support is delivered in a manner that maintains independence. The home does not have evidence that shows all service user’s health is monitored. Medicines are not stored safely. EVIDENCE: Personal support is provided to service users to maintain their independence. Choice is an integral part of the care provided and risk factors are considered. As discussed earlier in the report health needs are met but evidence is not in place to evidence how this is achieved. Service users’ bedrooms reflect individual tastes. A requirement has again been made regarding medication. A discussion held with the manager indicated that the home is not fully in control of the support given to one of the service users who has diabetics. This service user rightly has free access to the village where he shops for his own food. He buys and eats foods that are not always compatible with the management of his diabetics. While the home recognises that is his right, the inspector was not shown documentation that would show that the home was fully aware of what to do should his sugar levels vary. His Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 Page 13 medication is managed by the district nurse who has trained staff to draw up his insulin injections the manager appeared to be unaware of the fact that the district nurse retains responsibility for the drawing up of the insulin. Again it was not clear if this arrangement is to promote the service user’s independence and was instigated by the home. This service users’ sharps bin was in his room. This could pose a danger to the both the service user himself and other service users. One of the clearest parts of the information available on service users is in folders supplied by a health care professional. This contains good detail on the service users and the health care support they get. The inspector observed good interaction between staff and service users, and between service users themselves. Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There have been no complaints since the last inspection. EVIDENCE: Service users have opportunities to make their views known. This is encouraged on a daily basis by all staff and on a one to one basis by key workers. A more formal way of sharing opinions occurs in house meetings. A complaints policy is in place to ensure complaints and the outcome are recorded. The home has a copy of Hertfordshire County Council Adult Protection policy and procedures. Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The garden is not suited to the service user group. The home was clean and fresh. EVIDENCE: On the day of the inspection the home was clean, bright and fresh. The decoration is very domestic and the overall impression is one of a comfortable and a relaxed environment. Service user’s rooms are personalised and reflect the personality of the service users. Service users are assisted in keeping their rooms hygienic and tidy. Some of the service users are very specific about how they want their rooms; this is, respected by staff. The gardens are not user friendly and the state of them prevents service users going into them. The garden furniture on the patio on the day of the inspection was green with damp and looked very unwelcoming. Requirements have been left on the garden in the past. The grass was overgrown and the garden is on a slope this could prevent some of the less Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 Page 16 able service user taking advantage of it. One of the service users is blind and the inspector could not see how this man could safely use the garden. The garden at the front of the house was well kept. This is not a private area and would not benefit the service users to the degree that a pleasing and accessible back garden would. Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing group meets the needs of the service users. EVIDENCE: The home was holding job interviews on the day of the inspection. Service users are not involved in the recruitment process. The home is reliant on agency staff and on the day of the inspection two agency staff were working in the home. Staff observed were very at ease in their interactions with the service users and there was good interaction between them. Staff create a relaxed atmosphere in the home. Given the poor quality of the care plans this was good to observe. Recruitment files were inspected and found to contain all the required documentation. Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home is not good enough. EVIDENCE: The manager is now part way through the Registered Managers’ Award. During the inspection the Manager appeared to be unsure of how the home functioned, where paperwork was and information kept on service users. The manager now must focus on being in control of the home and having a full working knowledge of all the documentation in the home. He must ensure that the paperwork in the home particularly the care plans are fully up to date and are available to staff in a user friendly format. A sharps bucket left in a service user’s room could have put the service users at risk. The Manager was vague about what would happen in the event of a fire in the home. This must be addressed and staff should be very clear about their role in the event of an Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 Page 19 outbreak of fire. This includes all staff working in the home on a temporary basis. Service users have an input into the running of the home. It is noted that the internal auditing system has identified many issues that the home needs to improve on. In the light of this and in the interests of proportionality at this stage notices of intended legal action will not be taken to allow the home to improve. Failure to achieve this will result in legal action being considered. This includes care plans, the administration and recording of medicines, meeting individual needs and providing a garden that is suitable and accessible to all the service users in the home however limited their abilities. Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 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 X 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X X 2 x Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 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 YA20 Regulation 13(2)(4)(a) Requirement Used medication sharps must be stored safely. Service users plans must identify how individual needs are met, monitored and managed. Care plans must be reviewed in the light of service users’ changing care needs and kept up to date. Failure to attend to this by the timescales given may result in legal action being taken. Timescale for action 28/06/07 2. YA6 12,14,15(2) 31/08/07 3. YA39 24 Watford and District Mencap must evidence the system in place for monitoring quality of care at Thorpedale and the results of the most recent quality assurance audit. This standard has been met. 28/06/07 4. Thorpedale YA37 12,(1)(a)(b) The home must be managed in DS0000019594.V343365.R01.S.doc 28/06/07 Page 22 Version 5.2 5. YA24 23(2)(o) a manner that is proactive in identifying the needs of the service users and in ensuring the health and welfare of the service user is protected. Maintenance issues must be addressed. The garden must be well maintained and be assessable to all service users who live in the home. Failure to meet the deadline set could lead to legal action being taken 31/08/07 6 YA42 23)4)(a) The health and welfare of the 30/06/07 service user must be protected this includes producing a fire plan and evidence that all staff and where possible service user know what to do in the event of a fire. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: 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 © 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 Thorpedale DS0000019594.V343365.R01.S.doc Version 5.2 Page 24 - 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. 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