Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 17/10/08 for Thurleston Residential Home

Also see our care home review for Thurleston Residential Home for more information

This inspection was carried out on 17th October 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The admission processes in the home were managed well, with visits and interviews arranged prior to a new resident moving in. Care planning and record keeping for the people living at the home was in good order, with consideration given to health and personal care needs.The home was light and bright and residents spoken to were happy with their rooms and they spoke positively regarding the manager and staff.

What has improved since the last inspection?

Care planning and risk assessments have improved since the last inspection. They were found to be in good order with clear detailed information to assist care staff to care for a resident. Medication administration and record keeping was found to have improved and now meet requirements. Staff recruitment practices and processes have improved since the last inspection. Sampled paperwork was in good order with records seen of all checks and references.

What the care home could do better:

The home needs to continue with the ongoing maintenance and decoration programme of the home to ensure that the accommodation and furnishings are of a high standard. Staffing levels in the home with regard to care, catering and domestic duties need to be reviewed and considered to ensure that there are sufficient numbers to ensure residents needs are fully met. In addition the social aspect of their care needs to be considered further to ensure that residents needs relating to social and leisure activities are fully considered and met. Following recent shortfalls and problems at Thurleston the home needs to build on the improvements found at this inspection and the provider needs to ensure that all issues are dealt with a proactive and timely manner.

CARE HOMES FOR OLDER PEOPLE Thurleston Residential Home Whitton Park Thurleston Lane Ipswich Suffolk IP1 6TJ Lead Inspector Pauline Dean Unannounced Inspection 09:05 17 & 23 October 2008 th rd X10015.doc Version 1.40 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 Thurleston Residential Home DS0000060474.V372831.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 Older People. 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. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thurleston Residential Home Address Whitton Park Thurleston Lane Ipswich Suffolk IP1 6TJ 01473 240325 F/P 01473 240325 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) Guyton Care Homes Ltd Manager post vacant Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 One named person under the age of 65 as detailed in the application for variation dated 2nd February 2006. 15th September 2008 Date of last inspection Brief Description of the Service: Thurleston Residential Home is registered as a care home for older people. The home can accommodate up to a maximum of 24 service users. Guyton Care Home Ltd, with Mr Balaratnan as the Responsible Individual, owns the home. The home is located to the north east of Ipswich about three miles from the town centre. The easiest approach is from the Norwich Road and Whitton Church Lane areas. The home was first registered in July 1996. It is a single storey building located in parkland, some of which is lawned and includes shrubs and ornamental trees. Some of the rooms look over adjacent fields, others over the grounds. The whole setting is tranquil and pleasant. There is parking at the front of the home. The original bungalow has been developed with the addition of ten bedrooms. The building is of wooden design built on stilts and incorporating beamed walls and ceilings. The main lounge and dining areas are located within the original bungalow and another lounge is situated in the new part of the home. The current range of fees, as at this inspection were said to be £355.00 to £500.00 per week (Respite – short stay fee). Transport, hairdressing, chiropody, newspapers, private telephone, toiletries other than basic toiletries which are brought for by the home and the services of a therapist, an Occupational Therapists and a physiotherapist are an extra cost. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection involved checking information received by Commission for Social Care Inspection (CSCI) since the last key inspection in May 2008. At the inspection, records and documents were inspected and we spoke to the manager, care staff and the people living at the home. The Annual Quality Assurance Assessment (AQAA) completed for the previous inspection was not required for this key inspection. A tour of the premises was completed on the first day of the inspection. Regulation inspector Pauline Dean conducted this unannounced inspection of Thurleston Residential Home on 17th October 2008 and on 23rd October 2008 the Commission‘s pharmacist inspector Mark Andrews visited to inspect the medication standard. A Statutory Requirement Notice was issued on 26th June 2008 following a breach in regulations. Two visits were completed by the pharmacist inspector to assess compliance and whilst there had been improvement some shortfalls remained. The Commission for Social Care Inspection (CSCI) decided at this stage that no further enforcement would be taken. Because of these concerns the Commission conducted a Management Review of the home and we met with the proprietor and manager on the 27th August 2008. At this meeting we discussed the action taken by the home around the management of medication and the shortfalls found, the management arrangements in the home and Improvement Plan completed following the last key inspection on 8th May 2008. During the inspection three people who live at the care home, two relatives, a kitchen assistant and two care staff were spoken with. What the service does well: The admission processes in the home were managed well, with visits and interviews arranged prior to a new resident moving in. Care planning and record keeping for the people living at the home was in good order, with consideration given to health and personal care needs. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 6 The home was light and bright and residents spoken to were happy with their rooms and they spoke positively regarding the manager and staff. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who come to live at the home can be confident that their needs will be fully assessed and these will be met. EVIDENCE: On the 17th October 2008 there were twenty-two people living at Thurleston Residential Home. At this inspection, the files and paperwork for three people living at the care home were sampled and inspected. We were able to speak to two of these residents and a third resident. The pre-admission paperwork for two people who had moved into the home since the last inspection was sampled and inspected. Both of these people had moved into the home in September 2008 and detailed pre-admission assessments had been completed. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 9 A Daily Living and Needs Assessment covering personal care and physical wellbeing had been completed prior to their admission to the home. For one person this had been conducted whilst they were in hospital. Where possible, and if the prospective resident wished their relatives had been involved in this assessment and signatures were seen of relatives who had been party to the admission process. In addition to the above information there was additional detail, which told us about the person’s ability to care for themselves and when they required assistance and support. We were able to find out about the care and support they needed and information was seen regarding the time the person wished to retire and get up in the morning. The information provided by this assessment provided a good basis for a care plan. No intermediate care is provided by Thurleston Residential Home. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home can be assured that their care needs will be met through their individual plan of care and they can be assured that their medication will be administered in a safe and secure way. EVIDENCE: Three care plans were sampled and inspected as part of case tracking of the care offered at the home. The care plan format allowed consideration of all aspects of the health, personal and social care needs of the resident. Care planning files were in good order with each file having a photograph of the resident. The care plan covered communication, mobility and dexterity, medical history, religious observance, social and family involvement with the resident. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 11 Within the care plans sampled there were good examples of detailed medical conditions and the management of them by care staff and healthcare professionals. The care plan outlined the support and action required by carers and the care offered by a district nursing team. Individual social activities were noted in the care plan and action had been taken to ensure that these needs were met. An example of this was the wish of a resident to attend church. They told us that they had been able to pursue this and the home actively supported them by ensuring they were ready after breakfast when they were collected for church. A second care plan seen covered goals relating to personal hygiene, dressing, mobilisation, eating, drinking & diet, communication, socialising, medication, continence, phobias & fears, special needs, sleeping & allergies & observations. This care plan was for a resident who had lived at the home for over two years and regularly monthly reviews of this care plan had been completed. The most recent was in September 2008. It was evident from the detailed records that some changes to their health care arrangements had been necessary. The management of diabetes had been considered and the resident’s doctor had conducted a review. In addition an assessment by a physiotherapist and an occupational therapist had been requested and as a result a new walking frame had been obtained. Within the care plan of the third sampled file it was evident that there had been some changes in their health care needs. The management of their insulin and self-administration were detailed in the care plan and in a risk assessment. Following a recent review of their care by the resident’s doctor more input from the District Nursing Service had been requested and implemented. Within the care plans of the two established long-standing residents there were completed Falls Assessment Stage 1 & 2 and a manual handling assessment was in place. For both residents a Waterlow Pressure Sore Prevention/Treatment Policy had been introduced and completed in July and September 2008. Both persons had been identified as having a high risk of falls and pressure sores and as such their care plans were seen to identify and deal with these specific care needs. All three residents are registered with a local GP practice. The resident who had been admitted recently had been able to remain with their existing GP. Within the care plan files there was evidence of visits to and from health care professionals. We were able to see that residents are supported and assisted to seek medical advice and assistance and visits to consultants were detailed within their care plan. The outcome of these visits was clearly recorded and care plan action changed to accommodate their needs. Examples of this seen Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 12 were the management of an ear infection and a hearing problem and the management of diabetes. During this inspection, we looked at all current medication charts and checked the medicines against them and we looked at the care notes for three people living at the home. We found there to be significant improvement in the way the home manages medicines indicating improved outcomes for people living there who are prescribed medicines. There are clear systems in place for the administration of medicines and record-keeping practices allow medicines to be accounted for. This indicates they are being given in line with prescribed instructions. Records are being audited frequently by senior staff to enable prompt identification of problems with medicines. We found that people wishing to self-administer some of their medicines are supported by staff and this is regularly assessed for risks. The competence of staff authorised to handle and administer medicines is being assessed following their training. The inspector discussed with the manager their strategy for sustaining this improvement. During this visit we were able to see residents joking and chatting with staff and staff were seen to be respectful and polite as they spoke to the residents. They were seen to knock on bedroom doors before waiting to enter. One resident spoken to said that staff were both kind and polite. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service People who live at the home should expect to be given choices about how they spend their time, visiting arrangements and meals. EVIDENCE: We were told that residents are able to choose whether to have their meals in their room or in the dining room. We found that the majority of residents choose to have their meals in the dining room. One resident told us that they are able to make choices with regard to when they get up and when they go to bed. They told us that they require some assistance, but they were enabled to be independent in completing their own personal care needs. Another residents said that they were able to mix with the other residents or stay in their room. One person said that they had a daily paper and they chose to read this in their room, but took their meals in the dining room. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 14 Within the care plans and assessment of two resident there was some detail regarding the social interests they had e.g. attending a day centre and the Caribbean Club, but in a third care plan there was limited information about their social care needs and it was difficult to see what they enjoyed doing. An activity programme was on display in the hallway for October & November 2008. This detailed both group and individual activities e.g. the Caribbean Club visit and the Holistic Therapist’s visits to individuals, alongside bingo and chair exercises. We were told that residents are told of the activities on offer each day. The manager and proprietor told us that a group outing had been arranged and transport booked. Initially eight residents had expressed an interest, but on the day only two residents had wanted to go. The home had therefore arranged an outing and lunch for these two people only. One resident told us that they were able to go to church and they knew of regular visits by clergy to the home. On the notice board it stated that there was a church service each month and Communion twice a month. Whilst it is acknowledged that some consideration has been given to the social aspect of care of residents, this is still limited. It is acknowledged that the home’s manager is getting to know the residents, but the need for an expansion to the programme of varied activities to meet resident’s wishes is needed. We note that some residents do have choice around the meals they eat and the outings and activities they attend. This was particularly noticeable when residents had moved in with established activities and outings, for they were encouraged to maintain these. The arrangements for visitors was considered with two residents. We were able to speak with the relatives of a resident. They spoke of being involved in their relative’s admission and they are able to visit regularly. They told us that they were made very welcome and they enjoyed having lunch with their relative in the small lounge. They said that their relative is pleased to be able to offer this hospitality. A second resident said that their family visit regularly and they are able to entertain them in their room when refreshments are brought to them or they go out with them. The manager said that residents are encouraged and supported to manage their own financial affairs for long as they wish and they are able. At the last inspection it was said that the services of an independent advocacy services had been found and residents who require this service would be introduced to this service. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 15 Records were seen on the care plan file of two recent admissions of the personal possessions and clothing they had brought into the home. At this inspection we met the home’s kitchen assistant. We were told that one cook was on leave and the other cook had gone off sick. This had created some difficulties for the home and some changes had been made to meals served in the home. On the day of the inspection, fish and chips was brought in rather than cooked on the premises. Fish and chips would have normally been served each Friday and as only one person did not want fish and they were to have egg and chips. The home has a 4 week planned menu. At each lunchtime meal there are normally two choices offered. We were told that as well as these choices, an alternative such as salad and soup would be offered. Nutrition records were kept. These should be completed following each meal, but whilst records were kept of the lunch each person ate, staff were not always detailing what dessert the resident had and the tea they had had. Furthermore the detail in this record was lacking in detail e.g. often the only information was ‘soup’ and ‘sandwiches.’ There was no detail as to the type of soup or sandwich. In addition there were gaps in the records regarding the dessert and tea menu choice on 14/10/08 & 15/10/08, whilst they had been completed for 12/10/08. Within the kitchen store room there was a good selection and variety of tinned, dried, fresh and frozen foods. The kitchen assistant told us that foods are purchased weekly from a local supermarket and twice weekly from a wholesalers. In addition other items are purchased from local stores and fresh fruit and vegetables are purchased from a local greengrocer. Food storage and rotation was managed well. There were three fridges, a large upright fridge for general food supplies, a smaller fridge for fruit and vegetables and a fridge for staff. In addition there was a large chest freezer, which was tidy and in good order. The home continues to use the publication – ‘Making Food Safely’ and a diary are in operation in the kitchen. This diary and a file entitled ‘Cleaning and Temperature Book’ ensure that management and staff are fully aware of the duties and tasks to be completed and the action that has been taken relating to catering in the home. Records are kept of fridge and freezer temperature checks. Throughout the week, these are regularly kept, but at the weekends there were gaps in the record keeping. This was discussed with the manager. One resident said that they had a good appetite and they said that they ‘would eat everything’. They told us that they enjoyed their meals. On the day of the inspection we were able to observe lunch and tea being served. Residents were sat in the dining room, which is a pleasant light room with modern Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 16 furniture. Whilst the majority of the crockery was matching and in good condition, the glasses on the tables were a variety of different shapes and sizes. This did detract from an attractive table setting. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect their concerns to be taken seriously by the care home. EVIDENCE: Copies of the revised complaints procedure were seen on display in the hallway and in each resident’s room in newly installed wall file holders. Unfortunately whilst some changes had been made to this document since the last inspection the Commission‘s contact address details were incorrect. The manager made these changes immediately and told us that updated copies will be in place when the home’s administrator revises the main copy. Since the last inspection, the home has received two complaints. These were to found on a central complaint log. They detailed the complaint raised and told us what action had been taken. We found that the home had operated in a sensitive way and the resident was satisfied with the outcome. The home has an Abuse Policy and Procedure in place. This had been reviewed and revised in June 2008. This document and other local authority documents detailed how to make a referral, outlining staff action, contact Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 18 details for the Commission for Social Care Inspection (CSCI), Police and Social Care. The manager told us that all carers have received Safeguarding training, with the most recent training course in June 2008. Two carers spoken to at this inspection confirmed that they had received Safeguarding training in the last year and staff records sampled and inspected for two new care staff members evidenced that they had received or were about to receive safeguarding training as part of their induction training. Both care staff spoken to were aware of what they should do if a concern is raised with them and they were able to clearly outlined how they would raise a concern. We were told that neither of these carers had had to raise a concern with the manager since the last year and the manager said that they had not needed to make a referral under Safeguarding. The Commission is not aware of any Safeguarding Alert referrals since the last inspection. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at Thurleston have homely, surroundings, which are kept clean and tidy. comfortable and safe EVIDENCE: A tour of the premises was conducted on this inspection. All communal areas, the laundry, kitchen, bathrooms and some toilets and bedrooms were seen. There were no unpleasant odours or smells. Thurleston Residential Home is a single storey property having all single bedroom accommodation, ten with en-suite facilities of a wash hand basin and toilet and the remaining fourteen with a wash hand basin. In addition there Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 20 are two assisted bathrooms and separate toilets located around with house. A new assisted bath had been fitted into one of the bathrooms. The manager told us that there is an ongoing decorating and maintenance programme. As bedrooms become vacant they are decorated and new carpet, curtaining and furniture are purchased. In addition, new carpeting had been fitted in the corridors as noted at the last inspection. This was evident as we were taken around the home. Two new residents had moved into rooms, which had been decorated and new carpet and curtains had been fitted. We were told that prospective residents are encouraged to choose the colour scheme for their room. This was confirmed by one of the residents. The manager said that there are currently two rooms vacant and these are to be decorated, with new carpets and curtains fitted and new bedroom furniture was on order. Communal areas comprise of a dining room and lounge at the front of the building and a smaller lounge at the rear of the property. Residents are able to use whichever lounge they wish. The front lounge and dining room are light and bright with residents using the lounge as their main TV lounge. Whilst the ironing board and steam iron were not found in the rear lounge as at the last inspection, the home continues to leave laundry for ironing in this room. Whilst this is a small matter, it does detract from the creating a homely and attractive room. We were told that new carpet is to be fitted in this lounge in the near future and it is hoped that the home will look at ways of encouraging and promoting the use of this room. The laundry room is to be found within the building. Care staff during the day are responsible for loading and unloading the machines. The home has one washer and one dryer, both industrial models. We were told that should the machines breakdown the home has a 24-hour breakdown service agreement they can call on. We noted that the washer has a variety of washing programmes and is able to wash clothing and bedding at high temperatures. The laundry room is small, with limited space for airing clothes. Care staff and the manager confirmed that the folding and ironing of laundry is completed elsewhere, normally at night by care staff. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home expect to be supported by staff with skills and knowledge to meet their needs. They can be assured that appropriate recruitment practice has been followed to safeguard their welfare. EVIDENCE: Staff rotas were sampled and inspected for the three weeks from 12th October 2008 to 1st November 2008. The manager said that the assessed needs of the residents had been considered when developing the staff rota. We were able to see that during the morning there are three carers and one senior carer, in the afternoon/evening there are two carers and one senior and at night two awake carers with a designated senior carer on call. We were told that the manager was on duty throughout the week and on Saturday. Whilst we understand that these hours are noted in a diary, the manager’s hours need to be detailed on the staff rota. On the day of the inspection, we were told that the home was short of staff in the kitchen, for one cook was on leave and the second cook was off sick. In addition a cleaner was off sick on the day of the inspection and the manager said that one of the carers was going to cover cleaning duties in the afternoon. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 22 At the previous inspection the home had a vacancy in their domestic staff and they were recruiting. During this inspection staffing levels were discussed with care staff. We were told that the home was experiencing a reduction in catering and cleaning staff on the day of the inspection, however, there was no evidence of any shortfalls in cleanliness of the home. Carers told us that they are asked to complete catering and domestic duties as well as their care duties, for example making tea, cleaning and laundry. Whilst it is acknowledged that this may not be the normal practice, the home does need to consider staffing arrangements carefully to ensure that completion of catering and domestic duties do not impinge on the social aspect of care. Whilst people living in the home were generally satisfied with the care they receive to meet their needs, they said there are times when they may need to wait a short time for staff support. We were told this is more noticeable in the afternoon and evening when carers are dealing with domestic duties. However during the inspection it was seen that call bells were answered promptly and staff were not seen to be hurried or stressed as they went about their duties. The manager said that approximately 80 of all care staff have a National Vocational Qualification (NVQ) Level 2 or equivalent. Nine staff have NVQ Level 2 in care and five staff have a NVQ Level 3 in care. Three carers have started a NVQ Level 2 in care, whilst one carer has started a NVQ Level 3 in care. Two domestic staff have completed a NVQ Level 1 in cleaning duties and a catering staff member has completed a NVQ Level 2 in catering. We were told that the home is looking to promote staff training to ensure that staff are fully trained to meet residents’ needs. The staff recruitment files of two care staff were sampled and inspected. Evidence was seen of good staff recruitment practices with records and checks in good order. All staff are expected to complete their Skills for Care induction training before commencing work and a training and development programme of training is in place. We saw evidence of basic training courses completed by the two carers, which included Food Hygiene, First Aid, Fire Safety, Safeguarding Adults, Dementia, COSHH and Manual Handling. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst many of the outcomes for people living in the home are positive they cannot be assured that the home will be managed in a consistent manner to ensure the home is run in their best interests. EVIDENCE: We were told from speaking to two carers and three residents that the home has a good staff team. Residents spoken to said that the manager was approachable and competent to manage the home. The manager said that they felt they had a good staff team to work with. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 24 The manager told us that they continue to update their knowledge and skills by attending appropriate training courses. They had recently completed a Wound Care course and they were looking to do a course entitled ‘Dignity in Care’ and a course on the Mental Capacity Act. In the future they said they were looking towards doing a Dementia Care training course. The manager told us that they felt supported by the proprietor who made regular weekly visits to the home. Regulation 26 visits and reports completed by the proprietor for August and September 2008 were seen. These were detailed reports completed over a two-day visit. There was evidence of discussion with residents, staff and management and topics covered included the environment, care plans, health and safety, resident’s finances, food and audits of medicines. Whilst we are able to see some improvements in the management and administration of the home it should be noted that the service has taken a long time to ensure that the medication procedures in the home ensure the safety of residents. A Statutory Requirement Notice was issued with respect of shortfalls in medication standards in June 2008, following on from a Statutory Requirement Notice, which was issued the previous year for similar shortfalls. Historically the home has taken a considerable time to make these improvements. The current manager has been in post since April 2008. Since the inspection the proprietor has informed us that they are in the process of making an application for registration. This is awaited by the regional registration team. Whilst staffing levels are considered in line with residents’ needs, there were issues around the lack of social stimulation and activities. This was the situation on the day of the inspection, for care staff covering domestic and catering duties in the absence of auxiliary staff members does impinge on the care given. As stated at the last inspection a quality assurance and quality monitoring system had been adopted by the home. We were told that a resident’s questionnaire had been issued and completed in February 2008. An analysis of these findings had been completed and as a result some changes had been made. The manager said that they were planning to survey residents and their relatives again in November 2008. A Residents’ Forum has been created in June 2008 and two meetings had been held. Following a recent tea party in September 2008 for residents and their families, relatives and residents had been invited to join the Forum. The manager said that they hope that this Forum will get involved in the Christmas activities at the home. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 25 The home holds small amounts of personal money for two of the three people sampled. The records and money held was in good order, with records and receipts accurate providing a good audit trail. The manager demonstrated good practices in the management of this money. Safe working practices in the home are promoted and encouraged through the provision of ongoing training opportunities such as Food Hygiene, First Aid, Fire Safety, Safeguarding Adults, Dementia, COSHH and Manual Handling. This was evidenced earlier in this report. Evidence of risk assessments were seen in care planning files which related to individual needs of the resident around mobility, accessing the garden and moving around the home. Consideration is given to maintaining independence and enabling the resident to do things for themselves. Health and safety checks and certificates were sampled and checked. Safety certificates were seen for the newly installed ARJO bath/shower, Malibu bath and the Parker Freedom manual hoist. The home’s maintenance person completes hot water temperature checks. These are currently completed monthly and the temperatures varied from 39°C to 43°C. Consideration is to be given as to the need to complete these temperature checks more frequently to ensure that all hot water temperatures are as close to 43°C as possible. Records are kept of fridge and freezer temperature are completed and recorded. However, whilst they are regularly recorded throughout the weekdays, there were gaps in the weekend recordings. The manager said that they would speak to the weekend staff about this. An incident report was seen at the inspection. The record clearly detailed the incident and the management of the incident. A record was made of the action taken and the manager said that this detail was added to the resident’s care plan file. No accident records were seen. Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP12 Good Practice Recommendations People living in this home should be able to exercise their choice of leisure and social activities, which they would like to do. Nutrition records should be completed in full to evidence that residents have a varied, wholesome and nutritious diet. The manager should review staffing levels with regard to social activities, domestic and catering duties to ensure that there are sufficient staff to meet all of the care needs of residents. 2. 3. OP15 OP27 OP31 Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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 Thurleston Residential Home DS0000060474.V372831.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!