Inspection on 14/03/07 for Thurlestone Court

This inspection was carried out on 14th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Thurlestone Court 16/02/06

Thurlestone Court 14/12/04

Thurlestone Court 20/07/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Thurlestone Court Thurlestone Kingsbridge Devon TQ7 3NZ Lead Inspector Margaret Crowley Unannounced Inspection 14th March 2007 10:00a 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 Thurlestone Court DS0000003843.V325254.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. Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thurlestone Court Address Thurlestone Kingsbridge Devon TQ7 3NZ 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) 01548 560737 01548 560737 Thurlestone Court Limited Mrs Yvonne Hooper Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (25), Old age, not falling within any other category (25), Physical disability over 65 years of age (25) Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age 50 Date of last inspection 16th February 2006 Brief Description of the Service: Thurlestone Court is a detached two-storey property standing in its own grounds in the coastal village of Thurlestone, in the South Hams area of South Devon. It is part of the Court Group of care homes, and is registered to provide care for 25 older persons who may also have a physical disability and/or dementia. Accommodation is provided in en suite rooms on the ground and first floor with a passenger lift providing access to the upper floor. Most rooms have very pleasant views. Aids and adaptations are provided to meet residents needs. Communal rooms are spacious and are situated on the ground floor. A large conservatory adjoins the lounge. Outside there is a level garden area. Fees currently range from £306-£460 per week. Written information regarding the home and the services provided is on display in reception and is given to prospective and new residents. A copy of the most recent CSCI Inspection report is available. Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 12 hours on 14th and 15th March 2007. Yvonne Hooper, Registered Manager was present throughout the inspection and Brigitte Harvey, the Responsible Individual’s representative, was present for part of the day, on each day. A tour of the premises was made and most rooms were seen. Records were inspected, including care and staff records. Twelve of the 20 residents in the care home were spoken with, including 6 in more depth, regarding the lifestyle in the home and the care services they receive. Staff on duty were observed and 5 were spoken with. In addition, 2 visitors were spoken with during the inspection. Feedback questionnaires were received from 12 residents, 8 relatives or friends of residents, and 9 staff. Feedback was also received from 2 general practitioners and the district nursing service. What the service does well: Residents said that “ the all-round standard is very high”, “I am happy and well cared for” and” I am very comfortable here”. Comments made by relatives included “they are excellent at providing a happy atmosphere in which my mother feels secure” and “they look after the care and needs of my husband so well”. Feedback from visiting professional workers was also positive about the quality of the care provided. Residents live in a home that is attractive, comfortable and clean. The home has a welcoming and homely atmosphere. Many residents lived locally prior to living at Thurlestone Court and are encouraged to maintain contact with family and friends. The home makes good links with village life and some residents enjoy using local amenities. Residents said that they enjoy the meals. The meals seen during the inspection were of a good standard and provided a wholesome and balanced diet. Every effort is made to use fresh produce. Residents receive care of a very good standard. They have clear care plans, which are reviewed regularly to ensure they receive the care they need. The home is well managed and has clear, efficient systems in place. The registered manager provides a good sense of leadership and direction. Residents praised her attentive approach and said “she always makes time to listen”. Staff said that they work together as a team. They value the support they receive and the training opportunities available to develop their knowledge and skills in caring for residents. Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 6 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. Thurlestone Court DS0000003843.V325254.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 Thurlestone Court DS0000003843.V325254.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): Standards1,3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear admission procedures ensure that residents’ needs are assessed and can be met at Thurlestone Court. EVIDENCE: Three residents who had been admitted recently were spoken with. They confirmed they had received good information regarding the home and had been assisted by their families in choosing to live at Thurlestone Court. Two residents said they were made very welcome on their arrival and praised the staff in helping them to settle in. They felt they were receiving the level of assistance that they need. One resident was very positive about the manager’s approach and found most staff helpful. She had raised her concerns about the inflexible attitude of a member of staff which the manager had addressed. A sample of resident’s records was examined and evidence was seen of good assessments and risk assessments undertaken with new residents. Thurlestone Court does not provide intermediate care. Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 9 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): Standards 7,8,9,10. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Residents have clear care plans, which enable their health and personal care needs to be met. Systems for the administration of medication ensure service users medication needs are met. EVIDENCE: Residents said that they were being well cared for and that the staff were kind. Relatives comments echoed this. Individual staff were praised for their attention to residents’ needs and friendly rapport. However, a few residents and two relatives said that staff were “very busy” at times. The inspector observed staff speaking to residents in an appropriate manner and respecting their privacy when entering their bedrooms. Feedback from the community nursing service, and general practitioners was very positive. They said that their assistance is sought appropriately, and the home “continues to give high quality care to its residents”. Evidence was seen of good, holistic care plans, which indicate how service users’ personal care, social, and health needs will be met. Care plans have Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 10 been improved to include more information regarding residents’ former lifestyles, interests and preferences. Residents’ records were well organised and up to date. Care plans and risk assessments are systematically reviewed each month and amended as necessary. Daily records showed that any concerns are recorded and addressed. As part of a new initiative, residents’ nutrition and hydration is promoted and monitored on a daily basis. The management said there have been positive outcomes for residents’ health, for example in few urinary tract infections occurring. There are clear policies and procedures for the administration and storage of medicines. Medications records were inspected and found to be complete. There is good storage of medicines. Where a resident self-medicates this is subject to risk assessment, and the resident has appropriate storage for the medicines. Staff who administer medicines have received training. Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 11 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): Standards 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to live a flexible lifestyle with activities available to provide interest for them. Residents are provided with a nutritious and well-balanced diet. EVIDENCE: Residents said that they can choose how and where they spend their time and routines within the home are flexible. Several residents choose to take their meals in their rooms. A weekly programme of activities is displayed and events take place involving the local village community. Activities are provided each day and a record is kept of these. There are good links with the local church and school. Residents spoken with said they enjoy going out for walks and one had attended an exercise group in the village hall that day. A new bell-ringing group has recently been established in the home. Some residents said they would enjoy visits out in the company’s minibus when these are available again. Other residents said they choose not to participate in communal activities. They prefer time spent individually with staff in their own rooms, but this may not always be possible due to the pressures on staff time. Comments received from relatives expressed concerns that a minority of residents could become socially isolated. In discussion, the registered manager said that she is Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 12 aware of this problem and they attempt to address it. Residents are encouraged to make suggestions regarding their choice of activities and are enabled to participate when they choose. There is an open visiting policy. Residents said that their visitors are always made welcome, and feedback from all relatives confirmed this. Residents praised the quality and variety of the meals. The meals seen during the inspection were of a very good standard. A balanced and varied diet is provided that meets residents tastes and dietary needs. Every effort is made to use local fresh produce. The management has introduced a new system to promote resident’s nutrition based on the “5-a-day portions of fruit and vegetables” concept. Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 13 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): Standards 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can feel confident that there are systems in place to address issues of concern, complaints or allegations of abuse. EVIDENCE: The home has a written complaints procedure that is on display and included in the residents’ guide. Residents spoken with said they would raise concerns with the manager or senior staff, either by themselves or via a relative. The manager said that no complaints had been received since the last inspection and none were recorded in the complaint book. The Commission for Social Care Inspection has not received any complaints since the last inspection. There is an adult protection policy and procedure which is accessible to staff. Staff said that they had received the “No Secrets” adult protection training in-house. The registered manager and senior staff have not yet attended multi-agency training in the protection of vulnerable adults. This was recommended at previous inspections. Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 14 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): Standards 19, 25, 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents live in accommodation that is attractive, clean and homely but the variable heating detracts from residents’ comfort and could place them at risk. EVIDENCE: A tour of the premises took place and most residents’ rooms were seen. The home was very clean, hygienic and free from unpleasant odours. The home is furnished to a high standard. All of the residents spoken with said they liked their rooms and many have personalised them to their individual taste. Many of the rooms have a pleasant outlook. The carpet in three first floor rooms identified required attention to prevent a trip hazard. The inspector found that the temperature in the building varied during the time of inspection. Radiators in the lounges and in bedrooms were cold, although the inspection occurred in mid-March. The registered manager confirmed that Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 15 the central heating is timed to go off at times during the day. Some residents and a relative informed the inspector that the bedrooms and the sun lounge were too cold. Oil filled radiators have been provided in some rooms as an additional form of heating. The inspector found that some residents’ hands were cold to touch. All residents have woollen blankets to cover their legs. The management was advised that the temperature must be comfortable at all times. Concerns regarding the heating were raised during the previous inspection. The registered manager said that the heating was always turned on if anyone complained of feeling cold. The home is registered to provide care for older people including those with dementia. There are limited means of assisting residents’ orientation and residents’ bedroom doors do not have their names to assist them. In discussion with the management, they were advised to consider ways of improving orientation in the building. Outside of the premises there is a patio area and pleasant garden, which is open to the main road through the village to the beach. The front door is not locked during the daytime, but the location of the entrance, which is situated away from office, means that people could enter or leave the premises unobserved. The management was advised to review the security arrangements. The registered manager said that there are currently few residents who are mentally frail living in the home and that staff assist them when they wish to go outside. A new device has been installed in the hot water system to prevent the spread of legionella and to control the hot water temperature to prevent residents being at risk of scalds. However, hot water from some outlets tested during the inspection was too hot. The registered manager said that the company’s health and safety officer tests the system regularly and is addressing the problem. Safety notices are still in place in residents’ rooms warning of unregulated water, but are of limited use for those who have dementia. The walls in the laundry have not yet been redecorated as recommended in previous inspections. Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 16 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): Standards27,28,29,30 Quality in this outcome area is good . This judgement has been made using available evidence including a visit to this service. Sufficient staff are employed to meet the care needs of the current residents. Staff are provided with training opportunities to enable them to develop their knowledge and skills in caring for residents. EVIDENCE: Communication seen between staff and residents during the inspection was friendly and positive. Both residents and relatives said that staff were kind, helpful and accessible, although comments were made that staff sometimes had limited time. Nine staff responded to questionnaires and five were spoken with during the inspection. Staff said they work together as a team and have good access to training. They feel they receive good support from the manager, receive regular supervision and an annual appraisal. A small minority of staff said that they would like more time to spend with residents. On the days of the inspection there were 20 residents at Thurlestone Court. The staffing rota was inspected. It was confirmed that the registered manager was on duty plus 3 care staff ,including a senior care assistant, from 8-2pm in and 2 care staff in the afternoon until 8pm, with one night staff who was awake and the second who sleeps on the premises, on call. The responsible individual’s representative and the registered manager said that there are sufficient staff employed to meet residents’needs by day and by night. They Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 17 confirmed that staffing levels are kept under review dependent on the needs of the residents. There is a range of experience within the staff group and 60 of staff currently hold the National Vocational Qualification certificate in Care at level two or above. There is a staff training plan that is displayed in the office and demonstrates a systematic approach to both mandatory training in safe working practices and care practice, which are provided in-house. In addition four staff have participated in an external course in Positive Dementia Care. Records were inspected of staff recently employed and provided satisfactory evidence of the recruitment and the induction processes. Criminal Record Bureau disclosures and Protection of Vulnerable Adults checks are processed centrally and the manager is notified when enquiries are complete. Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 18 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): Standards 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thurlestone Court is well managed with clear efficient systems in place. EVIDENCE: Yvonne Hooper, the registered manager, holds the Registered Manager’s Award and the National Vocational Qualification certificate in Care at level 4. She has many years experience in working in the care of older people, including several as a manager. She has recently gained the National Vocational Training Assessors Award. The home is managed efficiently and she the staff team work together well to create a homely environment for residents. Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 19 Residents or their representatives manage residents’ financial affairs. There was clear evidence of records kept of incoming and outgoing payments of any money held in safekeeping for residents. The amount held is limited. The home has is an annual quality assurance survey to gain the views of residents, relatives and staff. The results made available to residents and are included the resident’s guide. The responsible individual’s representative carries out monthly quality audits covering all aspects of the provision of the service, to ensure that standards are maintained. Regular meetings are held with residents and staff, and minutes were displayed. Routine health and safety maintenance processes are managed satisfactorily and records inspected were maintained up to date and accurate. Fire and accident records were in order. A resident discussed with the inspector her wish to have the fire door at the entrance to her room held open. The resident and the manager were advised that the door must not be wedged open and that only an approved hold-open device must be used. Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 3 x x 3 Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 21 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. 1 2 Standard OP25 OP24 Regulation 23 (2)(p) 16(2) Requirement Heating must be provided at a temperature for suitable for the needs of residents. The carpets in the 3 resident’s rooms identified must be repaired or replaced to prevent a trip hazard. Fire doors must only be held open by an approved hold-open device. Timescale for action 16/03/07 15/05/07 3 OP38 23(4)(9) 15/03/07 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 OP18 OP26 Good Practice Recommendations The manager and senior staff should attend the multi agency training in the protection of vulnerable adults The laundry should be redecorated Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Thurlestone Court DS0000003843.V325254.R01.S.doc Version 5.2 Page 23 - 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!