Inspection on 11/08/08 for Thurston House

This inspection was carried out on 11th August 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Thurston House 07/08/09

Thurston House 22/08/07

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOME ADULTS 18-65 Thurston House 90 High Street Newport Pagnell Buckinghamshire MK16 8EH Lead Inspector Joan Browne Unannounced Inspection 11th August 2008 13:30 Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thurston House Address 90 High Street Newport Pagnell Buckinghamshire MK16 8EH 01908 611 333 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) thurstonhouse11@yahoo.co.uk www.minstercaregroup.co.uk Minster Pathways Limited Miss Michelle Jackson Care Home 7 Category(ies) of Learning disability (0) registration, with number of places Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 7. Date of last inspection 22nd August 2007 Brief Description of the Service: Thurston House is a large end of terrace property with garden in Newport Pagnell. It is conveniently located for the amenities of the town centre; shops, cafes and pubs being just a few minutes walk away. The nearest rail stations are Milton Keynes or Wolverton. The area is well served by buses. Bus links to Milton Keynes are good. During office hours short-term car parking is available in marked bays almost immediately outside the house or in a car park across the road. During office hours long-term car parking is available in a designated area of the same car park. The home provides accommodation, care and support on a variable term basis for up to seven service users with learning difficulties. The home is an older style three -storey house. It does not have a lift. It is not suitable for a wheelchair user. All bedrooms are single and have en-suite (WC, hand basin and shower) facilities - two of the bedrooms have a bath in addition to the shower. One bedroom includes a separate dressing room. The service is staffed over 24 hours- usually four care staff during the day and two care staff at night. Staff support service users in the home and in accessing a range of educational, therapeutic and recreational services in the community. It works closely with local health and social services providers in meeting the needs of service users. The weekly fees are approximately £1700.00. Thurston House DS0000069649.V369556.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 that people who use this service experience adequate quality outcomes. This unannounced site visit, which forms part of the key inspection to be undertaken by the Commission for Social Care Inspection (CSCI) was undertaken by Joan Browne on 11 August 2008. The registered manager was not present at the inspection because she was on annual leave. Two team leaders deputising in the manager’s absence assisted in the inspection process, which lasted approximately five hours commencing at 13:30 pm and concluding at 18:20 pm. The CSCI inspecting for Better Lives (IBL) involves an annual quality assurance assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This document initially helps to prioritise the order of the inspection and identify areas that require more attention during the inspection process. The information contained in this report was gathered from service users’ notes, records kept by the home, a tour of the premises and discussions with service users and staff. Six requirements were made and these can be found at the end of the report in the requirement section with fuller discussion in the text of the report under standards 6, 9, 20, 24, and 42. Nine practice recommendations have been made and fuller discussions of these can be found in the text under standards 20, 22, 23 and 42. We (the Commission) would like to thank all the service users and staff who made the visit so productive and pleasant on the day. What the service does well: Staff support and enable people using the service to make decisions and choices for themselves. People using the service are supported and encouraged to keep in contact with family members. The staff team support and encourage people using the service to take part in activities appropriate to their age and culture inside and outside the home. Thurston House DS0000069649.V369556.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. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home has a system in place to ensure that prospective people to use the service needs are assessed prior to admission. EVIDENCE: At the previous key inspection work was in the planning stage to develop a new service user’s guide. Evidence of the service user’s guide being completed was not available during the site visit. A copy of a service user’s guide was seen but this was on the old provider’s format and was not current. We were told that the home had not admitted any new service users since the last key inspection. The home’s annual quality assurance assessment (AQAA) stated that ‘all service users admitted to the home have a full assessment prior to admission.’ The home uses a pre-assessment tool, which is a standardize document to assess prospective service users’ care needs. The AQAA reflected ‘that before the initial assessment is completed, the home would insist on the current care plan from the placing authority. The manager or a member of the senior team would then facilitate a meeting with the prospective service user their parents, carers and advocate if applicable.’ This practice enables the home to get as much information as possible from all relevant parties to ensure that the service would be able to meet all identified Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 9 needs. Evidence of pre- admission assessments undertaken was seen in the service users’ files whose care was case tracked. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Care plans and risk assessments for people using the service are not regularly reviewed. This could mean that all staff may not know individuals’ needs and preferences to promote an independent lifestyle and their safety could be compromised. EVIDENCE: Information in the annual quality assurance assessment (AQAA) stated the following: “All care plans are now more person centred rather than the medical muddle previously used.” We found this information not to be accurate. Three care plans were examined and they were not clear and easy to follow. The files examined contained information on individuals’ personal details; calendar and weekly diary; risk assessments; behaviour guidelines; assessments and reports; notes of meetings; accidents and incidents; financial details; personal inventory; medical information; correspondence; contracts sheets and other reports. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 11 The plans seen were not signed by service users to confirm their involvement in their development. There was no evidence seen in the plans examined to indicate that they were being used as working documents to reflect the delivery of care that was being provided. Evidence seen indicated that the plans were not updated six monthly to reflect individuals’ changing needs. For example, the care plan for a particular service user stated that staff should promote independence and encourage the individual to do their personal laundry. However, there was a change in the individual’s identified needs and staff were expected to do this task for the individual. The care plan was not updated to reflect the change in the identified need. We observed that service users’ calendars and weekly diaries were not up to date. For example, the last entry in one particular service user’s calendar was dated 15 March 2008. We also noted that individuals’ daily timetables for attending the day centre were not up to date. A requirement is made for the home to keep service users’ plans under review. This should ensure that all staff are aware of current changes to people using the service health and welfare. We observed that the home was still using the previous provider documentation template. Because of the change of provider a recommendation is made for the home to implement the new provider care documentation template to ensure consistency. From discussions with some of the service users it was evident that they were able to make decisions about their lives with assistance from staff when required. For example, we observed a service user looking at a holiday brochure and being supported by a staff member to choose an appropriate location for a holiday. Information on how to contact an advocate was displayed on the home’s notice board. We were told that some service users were managing their own finances. The AQAA reflected that ‘service users live in a home which allows them to make choices and take planned risks to live as positive a lifestyle as is achievable.’ Risk assessments seen for those service users whose care was case tracked were not updated regularly. The home must make sure that risk assessments are kept up to date to ensure that service users’ health and safety are promoted. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home ensures that people are able to participate in activities to meet their diverse needs. Their dignity and rights are respected in their daily life. EVIDENCE: Information recorded in the annual quality assurance assessment (AQAA) stated that ‘service users are supported in seeking and maintaining appropriate jobs, attending college and day services.’ Three service users were currently attending a day centre. We were told that a particular service user appeared not to be happy attending the day centre and they were currently being supported in the home by staff from the day centre. This arrangement appears to be working well and there has been an improvement in the individual’s behaviour. From discussions with service users and staff it was established that service users were able to access the local and wider community. They are Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 13 encouraged to take up leisure activities such as going to discos, the cinema and the leisure centre. One service user spoken to said that staff had escorted him on a bowling trip to the leisure centre on the morning of the site visit. Several service users were able to go out independently. During the site visit a friend visited one of the service users and they both went out to the town centre together on an outing. The home has its own transport, which makes it easier for service users to be transported. Staff spoken to said that family members and friends are always welcome to visit. They are able to visit service users in their room if they wish to. The home has a varied daily routine. Service users are able to rise and retire whenever they wish to. Two service users who are very independent tend to rise very late in the day and the home is able to accommodate their needs. The level of support required by service users varied. We observed that some service users required a high level of supervision and support with their daily living activity. Meals are planned with service users and are cooked by staff. We were told that on weekdays service users have cereals, toasts and drinks for breakfast. A cooked breakfast is provided on Saturdays and Sundays. A light meal of service users’ choice is provided at lunchtime and dinner is served in the evening. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 &20 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home has a system in place to ensure that people receive support with their personal and health care needs in the way they prefer and is sensitive to their race, age, and disability. Inconsistency in staff’s medication practice has the potential to put people using the service at risk of harm. EVIDENCE: The annual quality assurance assessment (AQAA) reflected that service users are given privacy with their personal care and wherever possible a staff member of the same gender provides personal care. Female service users are always assisted with personal care by a female staff. We were told that service users are able to make a choice of where they would like their personal care to take place. For example, service users can choose to have a shower in their room or use the communal bathroom if they wish to have a bath. Wherever possible service users are encouraged to do as much of their own personal care as they can with staff using verbal prompts if necessary. Service users are supported and encouraged to choose their own attire. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 15 Evidence was seen indicating that service users were registered with a local general practitioner practice. The AQAA stated that ‘the manager meets with the mental health lead at the local doctor’s surgery every six months to discuss any changes to service users’ health care needs.’ We observed in a particular service user’s care plan that staff were expected to monitor the individual’s fluid intake. A fluid balance chart record was seen however, it did not appear to be up to date. We also noted that it was identified in a particular service user’s care plan that the individual’s weight should be monitored monthly because they were loosing weight. However, since November 2007 there has been no monitoring of the individual’s weight and there was no information recorded in the care plan to reflect that there had been a change to the identified action plan. The AQAA stated that ‘the staff and service users have a good relationship with all local health care professionals such as the doctor, dentist, optician, chiropodist and podiatrist.’ The home uses a monitored dose medication system. There were no service users assessed as capable to self-medicate. Information recorded in the AQAA stated ‘that medication is only administered by trained staff deemed competent to do so.’ We were told that only senior staff are responsible for administering medication. We found some inconsistency in staff’s recording and administration practice. For example, several unexplained gaps were noted on the medication administration record (MAR) sheets examined. The blister packs were checked and we found that there were no tablets in the packets. This meant that staff had administered the medication but omitted to record their signature. A second staff member to minimise the risk of errors when transcribing did not countersign hand written entries recorded on two MAR sheets. Chlorophenicol eye drops (which are an antibiotic) that were prescribed for a particular service user was not recorded on an appropriate MAR sheet. A medication for a particular service user was written on the MAR sheet to be administered daily. However, staff were administering it every other day. There was no written evidence or audit trail to confirm that the general practitioner had amended the frequency of the medication. A requirement is made to ensure that arrangements are in place for staff to record and administer medication to service users appropriately to minimise any potential risk to their safety and well-being. To comply with best practice guidelines a recommendation is made to ensure that the home retain a list of staff members authorised to give medication, which includes a record of their approved initials. A further recommendation is made to ensure that handwritten entries on the MAR sheets are signed by two members of staff to minimise the risk of errors when transcribing. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home has a complaints procedure in place to ensure that people using the service or their representative are able to express their concerns and action taken to put things right. The arrangement in place for supporting people using the service with their finances needs to be reviewed to ensure that any potential risk of financial abuse is minimised. EVIDENCE: The following information was recorded in the annual quality assurance assessment (AQAA): “All concerns and complaints are acted upon swiftly and thoroughly with all parties concerned being informed at all times of the current situation. All service users understand how to make a complaint as do all family members and professionals.” Service users spoken to during the inspection said that if they had a concern they would discuss it with a staff member or the manager. The AQAA indicated that the home had received one complaint within the last twelve months, which was investigated within 28 days and it was upheld. We observed that a copy of the home’s complaints procedure was displayed on the notice board at the front of the home. The details relating to the Commission’s address needed to be amended. A recommendation is made in this report for the Commission’s details to be amended. The Commission has not received any complaints about this service since the last inspection. The AQAA reflected that eight incidents of restraints were recorded and we are concerned to know the circumstances of these and the type of restraint involved and will be contacting the provider to obtain more information. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 17 The home has procedures in place for responding to suspicion or evidence of abuse or neglect to ensure service users’ safety and protection. The home’s AQAA stated the following: “All staff have a good working knowledge of the local area safe guarding policy, all staff understand how to report any concerns they have regarding the safety of any service user. Behaviours are managed through appropriate guidelines all staff have a good understanding of these guidelines and how to manage behaviour using them.” Staff spoken to during the site visit were able to demonstrate the action to be taken if they suspected or witnessed any incident of abuse. However, there was some confusion over what further action would be taken after the incident was reported. For example, who would take the lead in the investigation. The AQAA reflected that the home has had two safeguarding of vulnerable adults referrals made within the last twelve months and one of the referrals is currently being investigated. The Commission has not been notified of these referrals. It is required that the home must notify the Commission of any safeguarding referrals and incidents, which has occurred in the home Staff spoken to on the day of the inspection said that they had undertaken training in the safeguarding of vulnerable adults. Evidence seen in the care documentation for the service users’ whose care was case tracked indicated that they have bank accounts. We were told that some people hold their own bankcards. A record is maintained of all daily transactions, however, the records seen were not clear and easy to follow. The transaction sheets for two service users were checked. On one of the transaction sheets there was a discrepancy. The record and the balance of cash left did not correspond. The sheet recorded a balance of £1.51 but the actual cash remaining was 0.52 pence, which meant that there was a difference of 0.99 pence that needed to be accounted for. The second service user’s transaction record and cash remaining corresponded. A recommendation is made for the system in place for managing service users finances should be reviewed to ensure that it is clear and easy to follow and all monies can be accounted for. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Although people live in a home that is clean and hygienic the lay out and size of the home does not fully promote their diverse needs and their safety. EVIDENCE: The home is a large end of terrace house situated in Newport Pagnell town centre. It is conveniently located for the amenities of the town. Bus connections to Milton Keynes are good. Car parking facilities are available nearby. The nearest rail stations are Milton Keynes and Wolverton. The accommodation is over four floors- cellar, ground, first and second floor. The home does not have a lift and it is not conveniently set out for a wheelchair user. There are gardens to the rear and side of the house, which are appropriately maintained. Entries to areas of the home are controlled by staff through coded locks. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 19 The ground floor accommodation is comprised of the lobby (which includes a small quiet area), hallway, living room dining room, kitchen and two bedrooms. The cellar, which is locked when not in use, accommodates the laundry, freezers and storage areas. Bedrooms are situated on all floors and have en- suite facilities with wash hand basins, WC, baths or showers. One bedroom has a separate dressing room. The bedrooms seen during this inspection were satisfactorily furnished and decorated according to the wishes of the service user, reflecting his or her interests. During the tour of the building the following maintenance and cleaning matters were identified as needing attention to ensure service users’ safety: • Missing tile on the wall in the kitchen needed to be replaced • The kitchen cupboard door was missing and needed to be replaced • Bathroom in bedroom 4 – the tiles and the seal around the bath were mildew and required re-grouting • The window frame in bedroom 3 was rotten and needed replacing • The radiator cover in bedroom 3 was lifting and needed to be made secure • The chair in bedroom 8- the upholstery was blood stained and needed to be cleaned or the chair replaced • The extractor fan in bedroom 7 shower area was covered in dust and needed to be cleaned • The missing toilet seat in the staff toilet needed to be replaced • The broken electrical socket on the top floor corridor needed replacing • The corridor wall on the second floor was covered in grime and needed to be cleaned The décor in some parts of the home and carpets looked tired and were in need of redecorating and replacing. The walls in the lounge area looked bare with no pictures. We were told that service users who presented with challenging behaviours tend to damage the pictures. It is essential that the registered provider must identify and record priorities for redecoration and refurbishment so that continuing improvement to the environment is carried out. Standards of cleanliness in the home were satisfactory and the home was free from offensive odours. The laundry room is situated in the cellar area away from where food is prepared. The floor was of a concrete type, which does not make it impermeable and it would need to be fitted with an appropriate floor covering. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The staffing levels in the home were satisfactory to ensure that people are supported by staff in sufficient numbers to meet their diverse needs. We did not have access to staff’s records to evidence if the home’s recruitment and training procedures were robust and effective. EVIDENCE: The present staffing of the home provides for four care staff in the morning, four care staff in the afternoon and two care staff at night. These staffing levels are considered satisfactory and enable staff to support service users in activities in the community while maintaining support to those who wish to stay at home. We observed staff interacting with service users in a kind and respectful manner and looked comfortable in their company. The home’s annual quality assurance assessment reflected the following: “All staff have the appropriate checks before commencing employment. This includes written application form, formal interview, two written references, PoVA check and an enhanced criminal record bureau check. Once staff commence employment they are inducted through the company induction program.” No evidence was seen to support these statements because the Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 21 manager was on leave and we did not have access to staff records. Staff spoken to on the day of the site visit confirmed that they had completed an application form and had attended a formal interview with the management team. They also said that they were in receipt of an enhanced criminal record clearance before starting work and had undertaken induction training. The AQAA stated that ‘the home access training from Milton Keynes Council as well as outside providers and in house trainers. All staff who are not qualified to NVQ level were currently working towards achieving the NVQ qualification and there was a training matrix in place.’ We were not able to access staff’s records to look for evidence to support these statements. However, staff spoken to said that they had been provided with training recently and some had achieved the national vocational qualification (NVQ) in level 2. Staff spoken to confirmed that regular staff meetings were held monthly and they are in receipt of regular one to one supervision. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home’s health and safety practices need to be improved to ensure that people using the service and staff‘s safety is not compromised. EVIDENCE: The annual quality assurance stated the following: “The home is run by a suitably qualified manager who has a NVQ 4 qualification and the registered manager’s award. The manager has been in post for the past 12 months.” The manager was not available at the time of the inspection visit because she was on leave. We were therefore not able to confirm what up to date training she had undertaken to update her knowledge skills and competence. Staff Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 23 spoken to said that the manager was supportive and approachable. They confirmed that regular staff meetings take place. We were not able to ascertain at this visit if the home’s aims and objectives were being achieved and what progress had been made in the home’s quality assurance processes. The AQAA did not reflect if the home has a development plan and if a stakeholder’s survey had been carried out. All sections of the AQAA were completed and the information gave a reasonable picture of the current situation within the service. The evidence to support the comments made was satisfactory, although there were areas where more supporting evidence would have been useful to illustrate what the service has done in the last year or how it was planning to improve. The fire panel record was examined and evidence was seen to confirm that regular weekly checks were taking place. Records seen indicated that regular fire drills were taking place. We also noted that an entry in the home’s diary dated 29 July 2008 reflected that staff had undertaken fire awareness training. To comply with best practice guidelines it is recommended that the names of staff members participating in fire drills should be recorded. Staff ensure that a record is maintained for all accidents and incidents that occur inside and outside the home. We observed that the daily food temperature record was not being appropriately maintained. Several unexplained gaps were noted. Staff must ensure that the food temperature record is appropriately maintained to ensure that food is served within the recommended temperature range. Staff were not being consistent by ensuring that opened packets of food and sauces are dated and labelled to ensure that they are eaten within the use by recommended date. Staff must ensure that opened packets of food and sauces are dated and labelled to comply with food hygiene guidelines. We observed some radiators in the lounge area; corridors and some bedrooms were not covered. These must be risk assessed for the risk they present to the people that use the service and action taken to minimise any identified risk. The temperature of the hot water in the hand washing basin in the kitchen- an area to which some service users do have access was 51 degrees Celsius. A hazardous warning sign should be placed over the sink to promote safety. We observed that some of the pictographic fire exit emergency escape lighting was not working. The home’s fire maintenance contractor carried out a fire audit on 7 August 2008 and the fault was highlighted. However, on the day of the inspection there was no evidence seen to indicate what action had been taken to remedy the fault. The home must remedy the fault on the emergency lighting to ensure service users’ and staff’s safety is promoted and protect. Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 2 X X X 2 Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 25 No 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 15(2)(b) Requirement Care plans must be kept under review to ensure that all staff are aware of current changes to people using the service health and welfare. The home must make sure that risk assessments for people using the service are reviewed to ensure their health and safety are promoted. Staff must sign the medication administration record (MAR) sheets for medication administered to people using the service to minimise any potential risk to individuals’ safety and well-being The home must notify the Commission of any safeguarding referrals and incidents to comply with current regulation. The maintenance and cleaning matters identified as needing attention in standard 24 of this report must be addressed. To ensure that people live in a home that is kept in a good state of repair internally to promote their safety. Uncovered radiators in the DS0000069649.V369556.R01.S.doc Timescale for action 20/09/08 2. YA9 13(4)(c) 20/09/08 3. YA20 13(2) 20/09/08 4 YA23 37(1)(e) 20/09/08 5. YA24 23(2)(b) 10/10/08 6 YA42 23(2)(p) 10/10/08 Page 26 Thurston House Version 5.2 lounge area, corridors and some bedrooms must be risk assessed for the risk they present to the people that use the service and action taken to minimise any identified risk. 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 YA20 Good Practice Recommendations To comply with best practice guidelines the home should retain a list of staff members authorised to give medication, which includes a record of their approved initials. To comply with best practice guidelines handwritten entries on the medication administration record (MAR) sheets should be signed by two members of staff to minimise the risk of errors when transcribing. The home should amend its complaints procedure to ensure that it reflects the Commission’s change of details. The arrangements in place for supporting people with their finances should be reviewed to ensure that transaction sheets are clear and easy to follow. To comply with best practice guidelines the names of staff participating in fire drills should be recorded in the fire log. To comply with best practice guidelines a food temperature record should be maintained to ensure that food is served within the recommended temperature range. The home should ensure that opened packets of food and sauces are dated and labelled so that food is eaten within the use by recommended date. The fault on the emergency fire exit lighting should be remedied to ensure that people using the service and staff’s safety is protected and promoted. A hazardous warning sign should be placed over the washhand basin sink to ensure service users’ and staff’s safety. 2. YA20 3. 4 5 6 7. 8 9 YA22 YA23 YA42 YA42 YA42 YA42 YA42 Thurston House DS0000069649.V369556.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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