Inspection on 22/08/07 for Thurston House

This inspection was carried out on 22nd August 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 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 11/08/08

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 09/07/2008.

CARE HOME ADULTS 18-65 Thurston House 90 High Street Newport Pagnell Buckinghamshire MK16 8EH Lead Inspector Mike Murphy Unannounced Inspection 22 August 2007 10:00 Thurston House DS0000069649.V348631.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.V348631.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.V348631.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) Minster Pathways Limited Miss Michelle Jackson Care Home 7 Category(ies) of Learning disability (0) registration, with number of places Thurston House DS0000069649.V348631.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. This was the first inspection of this service since it was acquired by Minster Pathways Date of last inspection 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 having 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. Fees at the time of this inspection in August 2007 were £1700 per week. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector in August 2007 and included an unannounced whole day visit to the home over the course of a Wednesday. The inspection included discussion with the manager and staff, interaction with service users, consideration of information supplied by the registered manager in advance of the inspection, consideration of CSCI survey forms completed by service users, a tour of the home and grounds, observation of practice, and examination of records. The process included tracking the care of three service users and consideration of how the home was addressing the equality and diversity needs of its service users. This is the first inspection of the service under its new proprietors, Minster Pathways. The home is located in a good position for the amenities of Newport Pagnell town centre, and, through the use of its own transport or local buses, those of Milton Keynes City. It is an older style house with the accommodation located over three floors and a basement. The quality of the accommodation varies but Minster Pathways, who have recently acquired the service, have begun a programme of refurbishment. All bedrooms are single and all have en-suite facilities of shower, hand basin and WC - two of the bedrooms have baths as well. The quality of the shared accommodation is fair but is due to be improved before the end of 2007. The home has a system in place for assessing the needs of prospective service users. The home offers a respite service but many of the current service user’s have lived there for a number of years, so lengths of stay are variable. The home liaises with local healthcare services in meeting the needs of service users. Its systems for care planning are thorough and comprehensive but do not facilitate the involvement of service users in their care. The new manager is hoping to establish Person Centred Care Plans (‘PCP’s) in the near future. This would be a welcome development. Staffing levels are good and are sufficient to provide support to service users both in the wider community and in the home. Service users participate in a range of recreational, social and therapeutic activities and the home is planning a number of short breaks away in the autumn of 2007. Staff skills are maintained through NVQ and other training and through supervision. The home is making good progress with NVQ training and has a system of one to one staff supervision in place. Arrangements for other training had not been fully agreed at the time of this inspection. The home benefits from the comprehensive training programme offered by Milton Keynes (MK) Council but it may also need to seek other training providers – either to supplement the NVQ and MK programme but also for specialist subjects (such as advanced training in the administration of medicines). Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Continue to invest in improving the quality of the environment so that service users benefit from living in a pleasant home. Make care plans more accessible so that service users can participate in the process of care planning. Ensure that the storage, control and administration of medicines conforms to current best practice and takes account of guidance from the Royal Pharmaceutical Society of Great Britain. This should minimise the risk of errors in the administration of medicines to service users. Draw up a staff training programme, based on a staff skills analysis, to ensure that service users are care for by well trained and well supervised staff. Ensure that the home meets all relevant health and safety regulations and guidance so that service users live in a safe environment. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 7 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.V348631.R01.S.doc Version 5.2 Page 8 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.V348631.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service aims to provide a prospective service user with the information necessary to decide if the home is likely to meet his or her needs. The needs of prospective users are assessed by an experienced manager before admission. This aims to ensure that the home can meet the person’s needs and to avoid the admission of a person whose needs it cannot meet. EVIDENCE: The home has a statement of purpose (SOP) which includes the information required under Schedule 1 of Regulation 4. The organisational structure, which includes details of current staffing, and the reference to the gender of current service users (page four, first paragraph, second sentence) will need updating from time to time. The home is also in the course of producing a service user’s guide (SUG). A draft copy of which was provided for this inspection. The draft was an informative, colourful and well presented document. In order to fully meet the standard it will need to include the information required under Regulation 5 of the Care Home Regulations 2001 and that listed in standard 1.2. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 10 Referrals are usually received from local authority social services care managers. The registered manager (the manager) receives a copy of the care plan for the prospective service user. This normally includes an assessment of risk. Where the referral is accepted the manager makes arrangements to meet the prospective service user at his or her current place of residence to carry out an assessment. In carrying out the assessment the manager acquires information from the person being assessed, from those who are currently providing care (family or care professionals), and from relevant records. The assessment is structured by a form which acquires information under the following headings: Accommodation; Personal Support Needs; Communication Needs; Physical Health; Mental Health; Professional Input; Special equipment required; ‘Cultural/Faith’; Educational/Employment needs; Family/Friends; Financial Support; Risk Management; and, Compatibility with other service users. The prospective service user can be put in contact with an independent advocacy service if required. In Milton Keynes the manager said that this would be ‘People’s Voices’. The information acquired through the assessment is then considered by managers. The service is currently known as a ‘respite service’ and as such is considered to meet the criteria outlined in standard 3.10. Where it is decided that the home can meet the person’s needs, an offer of a place is made. In the first instance this is made to the referring care manager to ensure that the referring authority is willing to fund the place. Where this is agreed the offer is made to the prospective service user. The prospective service user is invited to visit the home and have tea with current service users and staff. A provisional plan of care based on the earlier assessment is drawn up. If the person wishes an overnight stay, then that can be arranged. If all parties (the prospective service user, his or her family, the care manager, and the home) are satisfied then admission is arranged. In the first instance this consists of admission for a ‘trial period’. The arrangements for admission are flexible and the transition from the person’s current place of residence to the home can be adjusted to take account of individual needs. The ‘Service User Agreement’ states ‘The first 3 months of your placement at Thurston House is a probationary period’. The manager said that the home is open to accepting an emergency admission but has not done so recently. The contract is part of the service user’s guide (currently at the draft stage). The contract differs from the SUG in style and is not in a form appropriate for all users of this service. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users care plans are based on comprehensive assessments of needs and support the provision of appropriate care. However, the structure of care plans is complex and does not facilitate the involvement of service users in the process. EVIDENCE: The home’s staffing arrangements are sufficient to ensure that service users receive the care and support they need. The needs of service users vary, not just on an individual basis, but also because of the home’s status as a ‘respite’ home. Some service users have lived there for many years, others for just a few months. A care plan is in place for each person living in the home. For the time being the home is continuing with the care plans used by the previous managing Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 12 organisation. While these are comprehensive, they cannot be said to be appropriate for this type of service and therefore, fail to meet standard 6.7. The manager has a draft format for person centred plans (PCPs) and has plans to develop a PCP for each service user in the near future – although a precise timescale has not been set. This would be a welcome development. In broad terms, service user files include the following sections: personal details; calendar and weekly diary; care plan; risk assessments; behaviour guidelines; assessments and reports; notes of meetings; accidents and incidents; likes and dislikes; strengths and needs; financial details; personal inventory; medical information; correspondence; contact sheets; and, other reports. The care plans of three service users were examined more closely. Those care plans included a photograph of the person, pictures of objects of reference, a diary and calendar for six months, a ‘care plan’ which included; spiritual needs, involvement of advocacy, emotional support, contacts with family, support with healthcare, support in dealing with anxiety, accessing the community, medication, and, activities. Other care plans had notes on; mental health needs (identifying and responding to psychotic symptoms), support with studies, decision making, challenging behaviours, support with daily living activities (such as budgeting, doing laundry or household tasks), cultural issues, finance and using transport. Risk assessments included risk related to potential exploitation while in the community, inappropriate behaviour, using stairs, road safety, or risks associated with transport. Notes are made at the end of each staff shift in a separate hardback notebook for each service user. Those examined included a good account of the person’s participation in activities, mood or other relevant information. Care plans are reviewed quarterly. A more comprehensive review, with funding and other agencies, is carried out annually (although Minster Pathways had not yet run the home for a year at the time of this inspection). Staff were observed to work in partnership with service users, supporting people in making choices. Arrangements for the storage of confidential information are satisfactory. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 13 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, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users lead a varied lifestyle according to their individual interests, abilities and wishes. This ensures that people living in this home have experience of a range of social, leisure and other activities and are involved with the local community. EVIDENCE: None of the service users service users at the time of this inspection were attending college. However, service users have attended in the past and would be supported if any wished to do so again. Service users requiring assistance with benefits would normally receive this via their social worker or direct from the benefits office. The home is in a good location for the amenities of Newport Pagnell and of Milton Keynes city centre. The home has its own minibus which is used daily. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 14 Service users have a Milton Keynes bus pass which allows them free travel. All service users are registered to vote. The manager intends putting up notice boards advertising local events, places to visit (and those visited) and others matters of interest to people living in the home. The service users and staff are from diverse ethnic backgrounds. Service users are able to access a range of leisure facilities in the locality. One service regularly plays football with a local team. The home has a minibus which is used regularly for outings. Service users are entitled to reduced rate entrance to the cinema in Milton Keynes. About once a quarter a night club in Milton Keynes holds a special disco which some service users go to. Many service users go to a social club – Club 64 – every week. Minster Pathways will pay up to £300 of the cost of a holiday for service users. Day trips out and three or five night breaks are planned for the autumn of 2007. Most service users maintain some contact with their families. Service users may have visitors in their rooms if they wish although issues of vulnerability, consent and potential exploitation need to be considered with staff. The home’s daily routine varies but the manager said that most service users are up by mid-morning. Two people have more variable routines and the home accommodates these. Staff support service users in maintaining independence as far as possible. The level of support required varies: some service users requiring a high level of supervision and support with most activities, while others have a high level of independence. One service regularly goes to a local pub to play pool with other customers. There are some restrictions in accessing certain areas of the house - such as the laundry and the kitchen – to protect some vulnerable users. Meals are planned with service users and are cooked by staff. On weekdays breakfast consists of fruit juice, cereals, toast and drinks. A cooked breakfast is offered on Saturday and Sundays. Lunch is a light meal such as sausage rolls or quiche and salad or sandwiches. Dinner is served in the evening. Main courses from the dinner menu around the time of this inspection may have included; Chicken Kiev and New Potatoes, Fish Fingers and Potato Waffles, Roast Lamb, Potatoes and Vegetables, and Pork Chops, Potatoes and Vegetables. A roast meat dish is usually served on Sundays. Service users are weighed monthly – more often where necessary. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 15 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff provide support to service users as required. Arrangements for liaising with health and social care services in the community are satisfactory. These aim to ensure that people’s healthcare needs are met. However, weaknesses in the home’s arrangements for the control and administration of medicines need to be addressed to minimise risk to service users. EVIDENCE: Staff provide support to service users as needed. The present staffing offers support to those service users wishing to access a range of services in the community while maintaining support to those who prefer to remain in the house. Service users are registered with a local GP practice. Individual needs are recorded in care plans. It is expected that the current care plan format will be replaced with PCPs in the near future. This should support greater service user involvement in their care. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 16 The home liaises with health and social care services as required. On the day the inspection the home received visits from a pharmacist and a psychologist. References were noted in care plans to liaison with psychologists, community psychiatric nurses (CPNs), speech and language therapists and psychiatrists. The references included correspondence on particular aspects of care (such as the management of certain aspects of behaviour) and notes of multi-agency review meetings. A chiropodist visits regularly (additional payment required - £14.00 at the time of this inspection). Opticians are available in Newport Pagnell and Milton Keynes. It is reported that NHS dentistry can be difficult to access in Milton Keynes. This should be taken up on behalf of service users with commissioners of services and the local Primary Care Trust (PCT). The organisation has a policy governing the administration of medicines. Medicines are prescribed by the service users GP and dispensed by Boots Chemists. The home has recently changed the pharmacy which supplies medicines and staff are familiarising themselves with the Boots monitored dosage system (MDS). All staff are to receive training in the Boots system – the manager had a copy of the training package. Training to date has included a video training package, questionnaire and supervised practice. Medicines are stored in cabinets on the ground floor. Medicines are administered by the person in charge of a shift. With the exception of one service user who managed her own inhaler, no service user was administering their own medicines at the time of this inspection. No medicines required cool storage. Examination of medicines administration records (‘MAR’ charts) indicated that practice was generally satisfactory but some matters require management attention. It was noted while reading a care plan that a service user was noted to be allergic to Penicillin. This information was not recorded in the medicines administration file. A handwritten entry for Lorazepam ‘PRN’ (to be administered when necessary) did not include reference to the authority to administer the medicine and the entry was not signed (two signatures would be desirable in such circumstances). A medicine to be given once a day had four timescales printed against it (this was outside of the home control but should be taken up with the dispensing pharmacy). Guidelines for ‘PRN’ administration (e.g. indications and maximum number of doses in 24 hours) would be advisable. References available to staff included a British National Formulary over five years old – although the manager said that a more recent edition was available in the home. The manager undertook to consider obtaining a copy of a BMA (British Medical Association) text on medicines. The location of the Royal Pharmaceutical Society of Great Britain publication ‘The Administration and Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 17 Control of Medicines in Care Homes and Children’s Services’ seemed unclear. It would be helpful if up to date copies of such references were available to staff on the ground floor, close to where medicines are stored. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 18 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a policy and procedure for recording and investigating complaints. It has a framework of policy, reporting arrangements and staff training with regard to the safeguarding of vulnerable adults. Together, these aim to ensure that complaints are properly investigated and to protect people from abuse. EVIDENCE: The home has a complaints policy – although a leaflet summarising the process was not available at the time of the inspection. The policy includes reference to the CSCI (‘NCSC’ the former regulatory organisation) and aims to resolve complaints within 28 days. The complaints process is mentioned under the ‘Advocacy/Complaints’ section of the service user’s guide and under the ‘Concerns’ Complaints and Protection’ section of the statement of purpose. Service users may be put in contact with an advocate from ‘People’s Voices’ advocacy organisation if desired. Reference to the investigation of a complaint was noted on file – it is also noted that the final letter to the complainant included reference to the person’s right to refer the matter to the CSCI if wished. CSCI has not received any complaints about this service since the last inspection. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 19 The home has a copy of the Minster Pathways policy and the Milton Keynes multi-agency policy on safeguarding vulnerable adults (the term ‘safeguarding’ is now used to avoid confusion with the Protection of Vulnerable Adults (POVA) list). All staff are to attend training on safeguarding vulnerable adults run by Milton Keynes council over the next six months. With regard to managing aggression and violence all staff are to receive training in Strategies for Crisis Intervention and Prevention (SCIP) before the end of 2007. The manager reports that the majority of staff have undertaken training in de-escalation and breakaway techniques. The matter is discussed in one to one supervision and in staff meetings. Staff involved in incidents are given an opportunity to ‘debrief’ after the event. An extended episode of challenging behaviour occurred at one point on the day of this inspection and all staff were observed to deal with it calmly, professionally and successfully. There is a policy governing the management of service users monies. A bank account is opened for each person. Some people hold their own bank cards. A record is maintained of transactions – mainly a ministatement of each withdrawal. A pouch and box is held for each person, these are stored in a locked metal cabinet. The manager said that the system is to be changed in the autumn and that additional controls are to be introduced – including having two staff signatures for each transaction. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 20 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, 26, 28 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well located for the amenities of Newport Pagnell and it generally provides a safe, comfortable and pleasant environment for service users. However, standards in some areas of the environment currently fall short of those required in a care service and if not addressed, may, in time, have an adverse effect on people living in the home. 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 is 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. The home is not conveniently set out for a Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 21 wheelchair user – the floors above ground floor level would not be accessible and negotiating the ground floor could be problematic. There are gardens to the rear and side of the house. Entry is controlled by staff through coded locks. 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. The cellar also includes a pump to remove water. The first floor includes two bedrooms, bathroom (with WC) and a WC. The second floor has three bedrooms and the manager’s office. The garden comprises areas of lawn, flower beds, bedding plants, a summer house (used for storage), and areas for seating and activities. There is a small area for the storage of bins to the side of the house. All bedrooms have en-suite facilities (all seven with WC, hand basin and showers, and two with a bath). One bedroom has a separate dressing room. The bedrooms seen during this inspection were well furnished and decorated according to the wishes of the service user, reflecting his or her interests. The manager reports that bedrooms are to be redecorated over the coming year. The overall standard of the accommodation is variable but the manager said that there are plans to redecorate all areas of the home over the coming year. Some areas have been redecorated since Minster Pathways acquired the home earlier in the year. The walls of the living room looked bare and the manager explained that this was because it had recently been repainted and that pictures and posters had yet to be replaced. The floor of the laundry in the cellar had recently been removed because of flooding and had not yet been replaced. The kitchen is to be redecorated when work on replacing the boiler is completed. The bathroom on the middle floor, while functional, was dull and will benefit from redecoration. Standards of cleanliness and safety were generally satisfactory. A pedal bin in the bathroom didn’t operate properly. Pedals bins would be better than swing top bins in the kitchen. The laundry floor should be impermeable to water – new flooring is to be laid in the near future. The temperature of hot water was satisfactory – with the exception of one hand washing outlet in the kitchen where it was tested to be 60 degrees Celsius. Overall, this seemed to be a pleasant rambling house which accommodated a range of activity over the course of the day of inspection. The communal areas of the lounge and dining area allowed service users to be with others if they wished. The quiet area by the lobby was used for private conversations. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 22 Bedrooms are comfortable. The garden provides space for service users when needed. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 23 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, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are good and procedures for the recruitment of new staff are generally satisfactory. However, the staff training and development programme needs further development to ensure that that there are sufficient numbers of appropriately trained and supervised staff to meet people’s needs. EVIDENCE: The present staffing of this seven place home provides for four care in the morning, four care staff in the afternoon and two care staff at night. These figures exclude the manager but include the deputy manager and team leaders. 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. The day of this inspection visit was quite active with service users participating in a range of activities – both in the home and in the community. The staffing levels, both in the morning and afternoon, appeared sufficient to allow staff to provide appropriate support to each service user. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 24 Staff are provided with a copy of the General Social Care Council (GSCC) codes of practice during their induction. The manager is keen to support staff on NVQ courses but the home has not yet quite achieved the 50 figure required under standard 32.6. It should do so in the near future. Staff turnover for the current year is expected to be higher than average. This is attributed to a change in the provider organisation (and therefore, employer) earlier in the year. The manager believes that a number of former staff would have seen that change as a time to move on. New staff had been recruited in the meantime. The staff seen on the day of the inspection visit appeared to have the right qualities for the job. They were appropriately focussed on supporting service users – either in the home or on trip out in the afternoon. The home has a number of relief staff who cover annual leave, sickness or maternity leave. It was not using agency staff at the time of this inspection. Staff meetings are held monthly and the notes of meetings over the last quarter year were examined. Staff recruitment is managed from the home. Four personnel files were examined. Applicants are required to complete an application form. It is noted that although the form requires an applicant to provide their reason for leaving an earlier position, the design of the form does not provide a separate column for this. Applicants are required to complete a health declaration which is reviewed by the manager. Interview notes are made. Applicants are required to provide two referees. The status of referees, in terms of their relationship to the applicant, was not always clear. Staff are appointed under POVA First arrangements and are supervised until the Enhanced CRB certificate is received. In the case of the four files examined POVA First checks were received in all cases before the person took up post. CRB certificates had been received for three of four staff – one was still awaited. Discussion took place on the retention and storage of CRB certificates. CSCI and CRB policies on this can be accessed through the CSCI Professionals website (www.csci.org.uk/professional ‘Policy & Guidance: (for service providers and CSCI staff) Criminal Records Bureau Checks (incorporating POCA and POVA checks)’). A recent photograph was not on file for any of the staff – this is a requirement for all staff under Schedule 2 (of the Regulations). The manager was considering the home’s approach to staff induction, training and development. The organisation had taken over a home which had formerly been managed by a national organisation with a central training department. Current staff who had formerly been employed by that organisation were considered to be up to date with ‘mandatory’ training. The manager had yet to develop a clear programme of staff induction training and development. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 25 The current induction programme was examined. Although it served as an induction to the home it appeared to fall short of the more comprehensive induction standards outlined in the Skills for Care. The manager was intending to fully utilise the training opportunities offered by the local authority funded training programme for ‘Adult’s Social Care 2007/08’ and that offered by Boots Chemists in the administration of medicines (albeit based on the Boots MDS system). Other training providers may need to be considered. It would be desirable for the manager to draw up a training plan for the next 18 months or so. This should cover induction, basic training, update training, NVQ, and further training (in specialist subjects relevant to the work of the home). A system of one to one supervision is in place and all care staff have access to personal supervision. Staff spoken to over the course of the inspection visit confirmed this. Records are maintained and are securely filed in the manager’s office. All care staff will be attending training on dealing with aggression in learning disability services which is provided on a regular basis by the local authority. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 26 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, 38, 39, 40, 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run by an experienced manager who is in daily contact with the service users. However, there are a number of health and safety matters which require management attention in order to ensure that the health and welfare of service users is maintained. EVIDENCE: The registered manager had been in post for less than six months at the time of this inspection. Prior to this the manager had managed other care services including those for adults with a learning disability. The manager has completed NVQ Level 4 in Care and the Registered Manager’s Award (RMA). Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 27 The registered manager is therefore, appropriately experienced and qualified for the position. Since taking up her position in the home the manager has attended update training in Safeguarding Vulnerable Adults and has commenced training to be an NVQ assessor. The manager is supported by a deputy manager, who is currently pursuing the RMA, and reports to the operations manager. The manager aims to create an open, positive and inclusive atmosphere in the home. The manager’s work in improving the quality of the environment and her commitment to the service was recognised by staff. The manager was described as ‘supportive’ and ‘always there to support people’. Regular meetings are held in the home. The visit to the home in connection with this inspection took just under nine hours. Over the course of that time there were many situations with service users, staff and visitors which required the attention of the manager and which reflected a ‘hands on’ management style while maintaining an objective overview of the service. The organisation has a policy on equal opportunities, diversity and anti-oppressive practice. The manager had been in post for less than six months and the service had been managed by Minster Pathways for slightly longer than this. It was therefore, considered too early to see evidence – in particular outcomes - of systematic quality assurance processes. As indicated elsewhere in this report the organisation is investing in improving the quality of the service. This is mostly evident in the improvements it has made to the environment to date. These are partly planned – redecoration for example – and partly perhaps, in response to unexpected events – such as the need to replace the boiler and flooding in the basement. Both however, are moves in the right direction. The manager is keen to carry out a stakeholder survey towards the end of the year. This would include seeking the views of service users, relatives, staff, and of health and social care professionals. The methodology has yet to be decided. Managers have not yet drawn up a development plan for the home. Developments appear to have been ad hoc to date. This is fine at this stage and as mentioned earlier they are improving the quality of the service for service users. A development plan, covering the next year or two for example, would help clarify the direction the home wishes to go, how it views its strengths and weaknesses, it would help set priorities, and help in identifying the resources needed to achieve its plans. This would normally form part of the business plan. Apart from the changes in the environment to date the home is also considering its current status as a respite service. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 28 Regulation 26 (of the Care Homes Regulations 2001) visits are regularly carried out by senior managers and copies of reports filed in the home. Reports for the three months prior to this inspection were examined during the visit to the home. The home has a copy of the organisation’s comprehensive policy manual, a copy of which is available in the office on the top floor. Arrangements for safeguarding confidential information are good. Records are stored in the manager’s office which is accessible via a coded lock. The development of person centred plans (PCPs) should increase the involvement of service users in the care records. The home has a health and safety policy governing managerial and staff practice. At the time of this inspection the manager was looking at how the staff induction, training and development programme would ensure that all staff have basic and updated training in manual handling, infection control, first aid, food hygiene, safeguarding vulnerable adults, and dealing with aggression and violence. Training in health and safety in more general terms and in fire safety is already included in the staff induction programme. The manager expected to make use of the comprehensive training programme offered by Milton Keynes Council but other providers may also need to be involved. The home had recently received a visit from an environmental health officer. One outcome of the visit was an order to replace the boiler. This is due to happen in September 2007. A new windowsill is required and the kitchen is to be repainted once the new boiler has been installed. Arrangements for food hygiene are generally satisfactory. Relevant equipment is in place for recording food and refrigerator temperatures and records maintained. Opened food in the fridge in the kitchens was labelled with the date of opening. Opened bottle of sauce (such as Mayonnaise) did not include a ‘use by’ date although the manager said that the practice is not to use such food beyond four weeks. The two freezers in the basement were noted to have an excessive amount of ice. This will impair performance in time and may pose a risk to service users. Both need defrosting and cleaning. The temperature of the hot water in areas to which service users have access is reported to be regulated by temperature control valves. However, 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 60 degrees Celsius. That in the washing up sink was significantly lower. The home’s fixed wiring was examined in 2003 and was found to be unsatisfactory (the home was under different management at that time). The manager was of the opinion that remedial work had been carried but evidence of a subsequent satisfactory report was not available at the time of the Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 29 inspection visit. Portable appliance testing (‘PAT’ testing) is arranged by the organisations head office. The home was inspected by the fire authority in May 2007. No recommendations were made other than a reminder to managers of the need for services to carry out a fire risk assessment. This was done in May 2007. Staff training on fire safety was last carried out in March 2007. Fire drills are carried out monthly. Routine fire checks are carried out weekly. A contract is in place for the maintenance of fire safety equipment. Arrangements for dealing with COSHH (Control of Substances Hazardous to Health) appear satisfactory. Relevant data sheets, risk assessments and suitable storage arrangements are in place. Systems are in place for recording accidents to service users, staff and visitors. Records were examined and in order. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 30 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 2 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 2 3 3 2 X Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? First inspection of this recently registered service 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 YA1 Regulation 5 Requirement Timescale for action 31/10/07 2 YA20 13 (2) 3 YA24 13 (4) 4 YA34 Schedule 2 The registered manager must ensure that the service user’s guide includes the information required under this Regulation The registered manager must 30/09/07 ensure that the home’s arrangements for the storage, control and administration of medicines minimises risk to service users The registered manager must 31/10/07 ensure that all areas of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. The registered manager must 30/09/07 ensure that staff records contain the information required under this Schedule RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000069649.V348631.R01.S.doc Version 5.2 Page 32 Thurston House 1 2 Standard YA6 YA19 3 YA20 4 YA20 5 6 7 8 YA22 YA35 YA35 YA24 It is recommended that the registered manager develop a format for care plans which facilitates the involvement of service users in planning their care It is recommended that the registered manager ensure that the relevant NHS authority is notified of any difficulties which service users encounter in accessing local dental services. It is recommended that the registered manager ensure that staff have access to current publications on medicines, in particular the guidelines on the ‘Administration and Control of Medicines in Care Homes and Children’s Services’ published by The Royal Pharmaceutical Society of Great Britain It is recommended that the registered manager ensure that the home’s arrangements for the control and administration of medicines conform to guidance published by The Royal Pharmaceutical Society of Great Britain It is recommended that the registered manager develop a summary of the home’s complaints procedure in a format appropriate to the needs of service users It is recommended that the registered manager develop a programme of induction for new staff which meets the standards published by Skills for Care. It is recommended that the registered manager develop a programme of staff training based on an analysis of staff skills and the needs of service users. It is recommended that the registered manager identify and record priorities for redecoration and refurbishment so that continuing improvements to the environment are carried out. Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Thurston House DS0000069649.V348631.R01.S.doc Version 5.2 Page 34 - 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. 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