Inspection on 07/06/06 for Thorpedale

This inspection was carried out on 7th June 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Thorpedale 28/06/07

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 Angela Dalton Unannounced Inspection 7th June 2006 10:40 Thorpedale DS0000019594.V298803.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.V298803.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.V298803.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 thorpedale@tesco.net 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.V298803.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2006 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.V298803.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection consisted of an unannounced site visit conducted by one Inspector. The visit took place on 7th June 2006 between 10.40 am and 4.30pm. Two service users were attending day care and two service users were at home with whom the Inspector spoke. There are currently three vacancies and the home recently experienced the death of a service user. The care delivered is of a high standard but the home has experienced challenges regarding staffing levels. A recruitment programme is underway to address this issue. The proportion of male carers to female service users is disproportionate and a recommendation has been made to record individual preferences with regard to personal care. This is because the rota does not always offer service users the choice between male and female staff. Disappointingly, most of the previous requirements remain unmet and may result in enforcement action. There have been no changes in service users since the previous inspection. 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 to better manage their diabetes but the care plan does not evidence how this is achieved and what support is provided. The garden remains unkempt and difficult for service users to access. Maintenance is needed regarding décor and fittings e.g. door handles missing, paintwork flaking off. Thorpedale DS0000019594.V298803.R01.S.doc Version 5.2 Page 6 No maintenance programme has been identified following a recommendation made at the previous inspection. Medication recording is still inaccurate and total amounts are not being carried forward. Accredited training in medication has previously been recommended but not yet occurred. No evidence is in place to reflect that staff have had training to manage insulin which must be in place. Out of date food was found in a service users’ fridge, which must not happen in future as it exposes a risk to them. Recruitment records could not be checked for newly appointed staff as they were not held within the home. A requirement has been made to evidence that appropriate checks have been made to safeguard service users. A requirement has been made to evidence how Watford and District Mencap have audited the quality of care provided at Thorpedale. 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. Thorpedale DS0000019594.V298803.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.V298803.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 An assessment is in place to identify how individual needs will be met. Placement fees for each service user were not available on the day of inspection. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to the 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 this would be reviewed by the company 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. Although residents’ contributions to rent are recorded the total charges were not available on the day of inspection. A recommendation has been made to provide this information to the Commission. Thorpedale DS0000019594.V298803.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Care plans and risk assessments do not contain adequate information to ensure a consistent approach to care provision. Service users are encouraged to make choices and maintain their independence. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to the service. 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 clearly provide a good standard of care but this is not consistent. It is not evident how staff assist a service user to manage their diabetes. There is no plan of care to identify the risks of diabetes, how to identify if ill effects are being experienced and how to manage them, or how diabetes is managed with appropriate nutrition. Staff will not work consistently as no approach is in place. Diabetes information is available in the individual’s file but it is unclear if staff are familiar with this. The same is true regarding a care plan for challenging behaviour. Guidelines are in place but there is no associated information to illustrate if they are effective or have been reviewed. Risk assessments are in place but they do not state what action to take should the risk occur. Thorpedale DS0000019594.V298803.R01.S.doc Version 5.2 Page 10 Information is still kept in several places: one service user has three files and information is not readily available for new or agency staff this m ay cause a problem in being able to identify current care needs. 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.V298803.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Service users participate in the running of the home and access the local community. This is however impeded by irregular access to the homes mini bus. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to the service. EVIDENCE: Some service users attend daycare and those who wish to retire and remain at home do so. An activities co-ordinator provides twelve hours of one to one support each week but this is soon to be reviewed, as it was part of the initial resettlement agreement for the newest service user. 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. Two service users went out to visit local gardens on the afternoon of inspection. Service users participate in planning meals and shopping for food. Thorpedale DS0000019594.V298803.R01.S.doc Version 5.2 Page 12 The Inspector discussed the possibility of the manager and staff team exploring the introduction of ‘healthy eating’ with all service users. This would support the service user with diabetes. Thorpedale DS0000019594.V298803.R01.S.doc Version 5.2 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 Service users’ health needs are being met but evidence is not in place. A safe medication recording system is not in place. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to the service. 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 but some are spartan and the manager plans to address this. A requirement has again been made regarding medication. Amounts of medication must be carried forward to enable reconciliation to take place. Medication is stored in a service users’ bedroom in a chiller style small fridge. Advice should be sought from a pharmacist regarding its suitability. The security must be addressed. Amounts of medication are still not recorded if stock was already in the home. The incorrect total was noted on several occasions. One service user has insulin injections which they administer independently. This previously occurred with the support of a district nurse. Thorpedale DS0000019594.V298803.R01.S.doc Version 5.2 Page 14 The report in August 2004 stated that if the service user became independent that a comprehensive self medication assessment must be in place with accredited training provided to the staff team by the district nurse. This has not occurred. The manager reported that a small number of staff had received training (but there is no evidence of this). There have been several staff changes since training was delivered so not all staff have this information. A recommendation has been made yet again for staff to receive comprehensive medication training. As some work has been undertaken regarding medication it has been decided in this instance enforcement action will not be pursued. However, further breaches within the administration of medication enforcement action will be considered. Thorpedale DS0000019594.V298803.R01.S.doc Version 5.2 Page 15 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 Service users are able to make their views known and are protected from abuse. Quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service. 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 keyworkers. 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.V298803.R01.S.doc Version 5.2 Page 16 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 & 30 The maintenance of the home is neglected and the garden is under utilised. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to the service. EVIDENCE: Requirements have been again made in relation to the peeling paintwork on the exterior of the windows. This will remain but it is understood that plans are in place to address the issue by the end of the summer. The kitchen floor has been replaced. The interior of the home was clean and tidy. The odours that were evident at previous inspections have been addressed. Furniture in empty bedrooms should be assessed for its fitness. Some of the fittings in vacant rooms require attention: A vanity unit is peeling to reveal veneer; paintwork was different shades where furniture had been moved. As stated earlier the previous recommendation to draw up a maintenance plan has been ignored. There are several environmental issues: cupboard and drawer handles are missing in the kitchen; carpet is missing in an upstairs toilet and there is no bin available. A toilet roll holder is missing; a door handle is broken and a service user’s room cannot be locked. The manager currently has no way of recording maintenance problems within the home. Thorpedale DS0000019594.V298803.R01.S.doc Version 5.2 Page 17 Although the home has a large garden it is not accessible to all service users as it is on a slope. There is a patio area with furniture but weeds made the area unattractive. As noted at the previous inspection garden furniture is dirty and there are still no patio umbrellas or seat cushions available which may encourage people to sit outside more frequently. The grass is still overgrown. The house is in a residential area and the unkempt nature of the garden continues to set it apart from its neighbours. It renders an already inaccessible garden more difficult for service users. Some pots displaying flowers were around the home but the poor state of the garden distracts from them. Thorpedale DS0000019594.V298803.R01.S.doc Version 5.2 Page 18 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): 32,34 & 35 The safety of service users is not assured by thorough recruitment checks. Specific training would assist staff in their care delivery. Quality in this outcome area is poor; this judgement has been made using available evidence including a visit to the service. EVIDENCE: A requirement has been made to send new staff documentation to the Commission. Evidence that recruitment checks had been conducted was not available in the home on the day of inspection. A member of staff was employed without the necessary checks to ensure service user safety. Their employment has been postponed until the necessary checks against the Protection of Vulnerable Adults’ register has been made. A protocol must be implemented if they are employed and supervised prior to receipt of their Criminal Records Bureau check. As discussed earlier staff would benefit from gaining insight into individual specific needs such as diabetes. A recommendation has been made regarding training. A recruitment programme is underway as there are a number of staff vacancies. The deputy manager is on long term sick leave and a temporary deputy has been recruited from an agency. Thorpedale DS0000019594.V298803.R01.S.doc Version 5.2 Page 19 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): 37,39 & 42 The manager is currently not registered for a management related qualification. Service users are at risk from poor health and safety practises in the home. Evidence of monitoring quality of service users care was not in place. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to the service. EVIDENCE: The manager was previously enrolled with a local college to commence their Registered Managers’ Award but the registration has lapsed. A requirement has been made for the manager to notify the Commission regarding their plans to gain the necessary qualification to manage the home. A requirement has been made for the company to evidence how it ensures a quality service is provided. Out of date food was discovered in a service user’s fridge. The Inspection was conducted on 7th June 2006 and the food had expired on 21st and 22nd May 2006. When staff were asked about this they Thorpedale DS0000019594.V298803.R01.S.doc Version 5.2 Page 20 reported that the fridge temperatures were checked daily. If this is the case it is unfortunate staff are not checking the contents at the same time. Fire records should reflect the time of fire drills and who attended. A recommendation has been made. Thorpedale DS0000019594.V298803.R01.S.doc Version 5.2 Page 21 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 2 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 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 2 X X 2 X Thorpedale DS0000019594.V298803.R01.S.doc Version 5.2 Page 22 Yes 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 YA6 Regulation 12 14 Requirement Service users plans must identify how indvidual needs are met, monitored and managed e.g. diabetes and challenging behaviour. THIS ISSUE HAS BEEN IDENTIFIED AT EARLIER INSPECTIONS. Care plans must be reviewed in the light of service users’ changing care needs and kept up to date. *Medication records must be accurately kept. *Amounts of medication must be carried forward and recorded to enable reconciliation to take place. *Medication must be safely stored. Evidence must be in place where staff have been trained to measure amounts of insulin for self administration. A comprehensive self medication assessment must be in place. These requirements have been brought forward from Thorpedale DS0000019594.V298803.R01.S.doc Version 5.2 Page 23 Timescale for action 31/08/06 YA19 15(2) 2. YA20 13(2) 14/06/06 3. YA24 23 4. YA37 9 5. YA39 24 6. YA43 13 the previous report and must now be addressed as a matter of urgency. Enforcement Action may be taken. The internal environment of the home must be well maintained. The garden must be well maintained and accessible to service users as it is too unkempt to access. The external window frames must be repaired. These requirements have been brought forward from the previous report and must now be met as a matter of urgency. The Commission must be notified of the manager’s decision regarding obtaining the necessary qualifications to remain a registered manager. 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. The health and safety of service users must be assured. Out of date food was discovered in a service user’s fridge which could have serious implications. 31/08/06 07/09/06 30/09/06 21/06/06 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. Refer to Standard YA5 Good Practice Recommendations A copy of placement fees/individual charges should be sent to the Commission. The individual contributions made by service users do not reflect the total fees charged. DS0000019594.V298803.R01.S.doc Version 5.2 Page 24 Thorpedale 2. YA6 A systematic process of reflection on and review of the home’s care plan format and records should be considered. Care plans should reflect service users’ preference of male or female carers. Risk assessments should reflect the action needed should a risk occur. It is recommended that service users have permanent access to the minibus which is loaned out regularly. Staff training in medication practice and procedures should be reviewed and use made of training such as that discussed at the inspection under the auspices of Hertfordshire LD Workforce training. A structured programme of routine maintenance and decoration should be drawn up, with dates for completion and funding identified, to ensure that the premises are well maintained. Service users should have access to a computer. Staff should have training on managing service users specific needs e.g. diabetes and challenging behaviour. Fire drills should reflect the time of practice and who was present. 3. 4. 5. YA9 YA13 YA20 6. YA24 7. 8. 9. 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