Inspection on 09/08/05 for Thorpedale

This inspection was carried out on 9th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 07/06/06

Thorpedale 14/02/06

Thorpedale 26/01/05

Thorpedale 03/08/04

Thorpedale 22/01/04

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Sun Court Nursing Home

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Paradise Lodge

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Upaya Ananda

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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 9 August 2005 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 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 Stationary 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 DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Thorpedale Address 1 Station Approach, Chorleywood, Rickmansworth, Hertfordshire, WD3 5AJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01923 284 648 01923 284 648 Watford and District Mencap Keith Philip Seager CRH 7 Category(ies) of LD(E)-7, PD(E)-7 registration, with number of places Thorpedale DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 26 January 2005 Brief Description of the Service: Thorpedale is a large, two storey, detached house that offers seven single occupancy bedrooms. One double bedroom has recently been divided to create two single bedrooms. The rooms are currently unoccupied as they require carpet and curtains. 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 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 DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector conducted this unannounced inspection on 9th August 2005 between 10.40am and 2.30pm. As the Manager was not on shift the Inspector conducted the Inspection with a Senior Support Worker. Overall the inspection was a positive one but requirements have been made, some of which have been carried forward from the previous inspection. Enforcement action may be considered if compliance is not forthcoming in the revised timescales given in this report. The home currently has one vacancy. What the service does well: What has improved since the last inspection? What they could do better: Requirements have been made to attend to medication records and appropriate refrigeration. The kitchen freezer was unclean and the kitchen floor remains in need of repair. The external paintwork on windows is flaking and the garden is unkempt and unwelcoming. Care plans lack details on individual needs specifically those that are health related i.e. diabetes, falls and challenging behaviour management. Thorpedale DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 6 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 DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Thorpedale DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 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 standard(s) 1,2,3,4&5 Service users are provided with the necessary information to enable an informed choice to be made about their home. EVIDENCE: Staff confirmed that service users had received a Service Users’ Guide. The most recent service user had familiarised themselves with the home through visits and meals. Assessments were received from care professionals and the home staff liaised with them to ensure all necessary information was acquired. Contracts are kept in individual files to reflect Terms and Conditions. Thorpedale DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 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 standard(s) 6,7,8,9&10 Specific requirements are not reflected in care plans. Service users are supported in maintaining independence and making choices. EVIDENCE: Care plans provide a wealth of historical information about service users. Some individual needs are changing and the documentation is not in place to reflect how staff are supporting service users with new needs. There was no care plan to identify how a service user is supported with managing diabetes and the change of medication to insulin injections. Another service user has experienced an increase in falls and another requires support with challenging behaviour but care plans did not identify how these needs are monitored or managed. Service users each have an individual keyworker to support them with specific needs and making choices. One service user is in the process of choosing a holiday destination and their keyworker is supporting this process. Risk assessments reflect that independence is encouraged and monitoring is ongoing. Two service users walk to the shop independently but their capabilities are reassessed at frequent intervals. Thorpedale DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 10 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 standard(s) 12,13,14,15,16&17 Service users participate in the running of the home and access the local community. EVIDENCE: Some service users attend daycare but one is in the process of reducing their attendance at their request. An activities co-ordinator provides twelve hours of one to one support each week. The service users are familiar with the local community and take full advantage of local facilities. One service user attends church and has befriended one of the congregation. The home has a minibus but this is on loan during the day on weekdays. It is recommended that this practise be reviewed to enable service users to have more regular access to the mini bus should they require it. One service user was going shopping to Watford using public transport on the day of inspection. Service users participate in planning meals and shopping for food. Thorpedale DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 11 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 standard(s) 18,19,20&21 Medication practice within the home does not safeguard service users. Service users receive individual support. 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. Service users’ bedrooms reflect individual tastes and some rooms have benefited from new furniture. A requirement has been made regarding medication. Gaps were seen on medication administration record sheets (MAR) and it was unclear whether staff had neglected to sign or medication had been omitted or refused. Medication was stored in a domestic fridge which is inappropriate. Amounts of medication were not recorded if stock was already in the home. This resulted in amounts of medication not being checked as there was no total to check against. One service user has recently begun to have insulin injections with a view to them becoming independent. If this occurs a comprehensive self medication assessment must be in place with accredited training provided to the staff team by the district nurse. A recommendation has been made for staff to receive comprehensive medication training. Thorpedale DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 12 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 standard(s) 22&23 Service users are able to make their views known and are protected from abuse. 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 DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 24,25,26,27,28,29&30 Some areas of the home were unclean. The maintenance of the home is neglected and the garden is under utilised. EVIDENCE: Requirements have been again made in relation to the peeling paintwork on the exterior of the windows and the missing seal from the kitchen floor. If the kitchen floor is not repaired an enforcement notice will be served as this is both a health and safety and infection control issue. The interior of the home was clean and tidy with the exception of the dirty freezer door (inside). One bedroom had an odour of urine and although staff are taking steps to manage this they are ineffective. The seal was broken on the oven door and this must be repaired. Furniture has been replaced in the previous twelve months in the dining room and in some individuals’ bedrooms. 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. Chairs were overturned and the patio was far from welcoming. There were no patio umbrellas or seat cushions available which may encourage people to sit outside more frequently. The grass was overgrown (although reportedly due to be cut on the day of inspection). Thorpedale DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 14 Borders are overgrown and the garden is a contrast in the residential area in which the home is situated. Thorpedale DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35&36 Staffing levels and skills are adequate to meet service users’ needs. EVIDENCE: The deputy manager is currently on long term sick leave. Other vacancies are being covered by consistant members of agency staff. Advertising to fill vacancies is taking place however, Thorpedale is adequately staffed due to assistance from a sister home who has fewer residents at the moment. Regular training takes place and some staff are working towards their NVQ qualification. Team meetings and supervision ensure that staff are informed of any recent developments. Quality assurance forms part of the Responsible Individual’s monthly visit. Thorpedale DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41,42&43 The health and safety of service users may be compromised. EVIDENCE: The manager works a combination of hours to ensure that he is both office based and aware of service users and staff needs. The ethos of the home is to support service users and maintain any progress that service users make. A requirement has been made to conduct risk assessments on the position of sharps bins and the use of recliner chairs. Fire records were checked and a requirement was made to record the staff and service users who attend fire drills. Thorpedale DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 17 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 3 3 2 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Thorpedale Score 3 3 1 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 2 3 DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 18 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 14(2) Requirement Service users plans must identify indiviual need and how they are to be met monitored and managed e.g. diabetes, falls and challenging behaviour. Medication records must be accurately kept. Gaps must not be in place for regular medication. Containers must be signed on opening. Medication requiring refrigeration must be sored securely and not with food or drink. Refrigeration temperatures must be recorded. Amounts of medication must be carried forward and recorded to enable reconciliation to take place. Department of Health guidance regarding Olanzepine must be observed. The environment must be well maintained. The garden must be well maintained and accessible to service users. The seal on the oven door must be repaired. The broken seal in the kitchen floor must be repired. AN ENFORCEMENT NOTICE WILL BE SERVED IF THE FLOOR IS NOT REPAIRED DUE TO PREVIOUS REQUIREMENTS NOT BEING Timescale for action 31/10/05 2. YA20 13(2) 31/08/05 3. YA24 23(2)(b) 16(2)(c) 23(2)(o) 31/10/05 Thorpedale DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 19 4. 5. 6. 7. YA30 YA30 YA41 YA42 13(3) 16(k) 23(4)(e) 13(4)(c) MET. The peeling window frames must be repaired. This requirement remains unmet and further action may be taken if this requirement is not observed. The inside of the freezer, 30/09/05 particularly the door, must be clean. The oudour of urine in the 30/09/05 bedroom must be addressed. Fire drill records must reflect 31/08/05 individuals who attended and at what time. Risk assessments must be conducted upon the presence of a sharps bin in a service users room and use of an electric recliner chair. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA13 YA20 Good Practice Recommendations It is recommended that service users have permanent access to the minibus which is loaned out regularly. The staff team should receive comprehensive accredited medication training. Thorpedale DI52 s19594 Thorpedale v243253 090805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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