Inspection on 16/09/05 for Town Thorns

This inspection was carried out on 16th September 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Town Thorns 15/08/07

Town Thorns 22/01/07

Town Thorns 23/02/06

Town Thorns 15/03/05

Town Thorns 09/11/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Town Thorns Brinklow Road Easenhall Rugby Warwickshire CV23 0JE Lead Inspector Lesley Beadsworth & Suzette Farrelly Unannounced Inspection 16th September 2005 09:30 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and 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. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Town Thorns Address Brinklow Road Easenhall Rugby Warwickshire CV23 0JE 01788 833311 01788 833379 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) BEN - Motor & Allied Trades Benevolent Fund Ms Helen Mary Owen Care Home 70 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (46), of places Physical disability (15) Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users accommodated into room 121 must be in the category of old age, not falling within any other category. 15th March 2005 Date of last inspection Brief Description of the Service: Town Thorns is purpose-built care home and stands in more than 20 acres of grounds. It is designed as a continuing care centre to provide full nursing, residential care and sheltered housing accommodation to people who are connected with the motor and allied trade. The home is divided into four units: Nursing Care, Dementia Care, Residential Care and Younger Adults with Physical Disabilities Units. Town Thorns is situated near the village of Brinklow close to Rugby. The home has facilities for service users to engage in social activities within the home and in the community. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day commencing at 10:30 until 20:15. The registered manager and deputy manager were present throughout the day. All four areas in the home were visited and an in depth assessment of residents outcomes and the service provision took place on the Younger Adults unit for those with physical disabilities and the Dementia Care Unit for older people. The remaining two units received a shorter inspection paying attention to the provision of care. The inspectors spent time talking to residents, relatives and staff and examining resident records. Later in the inspection time was spent discussing staffing, examining staff files and policies and procedure. What the service does well: What has improved since the last inspection? Since the last inspection there has been an improvement in the employment process and staff are now not employed unless all checks have been received. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 6 The home ensures that there is always adequate staff on duty to meet the needs of the residents. They are at present using agency staff to fill gaps, however a recruitment drive is at present occurring. The manager has gained her qualification as a licensee enabling her to open the conference room and serve alcohol. The homes’ Statement of Purpose now covers all areas required and gives a clear indication of how the home operates. The manager has attended training in the recognition, prevention and action in cases of abuse. Further training for staff is to be organised. What they could do better: The following areas must be addressed: • Nutritional risk assessments must be implemented for all residents, including regular weighing on a monthly basis. Where weight loss is occurring or there re other risks identified suitable care plans must be devised. Risk assessments for falls and manual handling must be developed and implemented with clear guidance to staff on actions to be taken where there is a deficit or risk to the resident. All medication must have a suitable label and staff must not alter labels but request new medication from the pharmacist. The manager must ensure that staff complete the Medication Administration Records correctly and that no gaps appear. It is recommended that the temperature of the room where medication is stored is monitored to ensure that it is at or below 25OC as recommended by the Royal Pharmaceutical Society. It is recommended that staff receive training in their specialist areas such as specific needs of residents with dementia, learning disabilities and dealing with challenging and aggressive behaviour. There is a need for consistency in care planning in the home, and to ensure that the needs of the residents are clear and concise. These must be evaluated monthly and where change occurs this must be reflected in the care plans. • • • • • • 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. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1, 4 and 5 were assessed The residents are given information that they need to be able to make an informed decision on where they live. Residents and their representatives have the opportunity to visit and assess the quality, facilities and suitability of home, and to know that the home can meet their needs prior to admission. EVIDENCE: The residents have given a copy of the Service User’s Guide on admission and are able to view this document prior to admission. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 9 The home also has a comprehensive Statement of Purpose that describes clearly the layout and purpose of the home. All residents and/or their representatives are encouraged to visit prior to admission. From discussion and records it was seen that residents have visited prior to admission and some were previous residents in the sheltered accommodation on site. All residents receive a full assessment prior to admission and they are informed in writing that the home can meet their needs. It was also seen in the residents’ profiles that there are care plans developed from the initial assessments. The pre-assessments are lengthy and mainly yes or no answers and it were difficult to extract the information required. These forms are filed separately to the care profiles and are not readily available for cross-reference. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 were assessed The residents’ health, social and personal care needs are not fully set out in the care plans and it was difficult to determine that all needs were met appropriately. The residents are not fully protected by the management of medication. The residents’ privacy and dignity is respected at all times maintaining their self worth and esteem. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 11 EVIDENCE: Seven care profiles were examined in depth during the inspection and it was noted that although there are care plans available, a number of these did not have all the information required ensuring that consistent care is given. In one care plan it states ‘ensure that the resident’s bed is working correctly’ yet there is no information on how this is to be done. An assessment on another resident indicates that there are some issues concerning relationships with men, and particular with male carers, again there is no care plan describing how this should be managed. On the general nursing unit the care plans were found to be clearer and more concise, the qualified nurse stated that these are rewritten every six months and the previous care plans are archived. It was difficult to see if the needs of the resident had changed during this period, as no clear records of evaluation were available. In a residents’ profile in the Dementia Care Unit it was clearly recorded that a resident had a temperature and a chest infection. There was no written guidance for staff on how frequently the residents’ temperature should be measured and actions to be taken concerning the chest infection. Staff spoken to on the units demonstrated an understanding of the needs of the residents some of this information was not readily available in the residents’ profiles. The sharing of practice, care delivery and information is reliant on memory and verbal communication, which may result in inconsistent care and omission of care. Nutrition risk assessments are not consistently carried out for all residents and where risks are recognised no suitable care plans were seen. The residents’ are not weighed monthly and in one profile there was evidence of slow weight loss, it was recorded that the resident should be weighted monthly yet this was not occurring. Psychological assessment was also inconsistent one profile had the Mini Mental Scale and Ill-being / Well-being scales; however good care planning in relation to the results was not available. It is suggested that this is used for all residents in the home as they demonstrate depression and other changes in mental well-being. Visits from other professionals were recorded in the residents’ profiles, the amount of information varied and follow up treatment and actions by the home were not always clear. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 12 The care planning, evaluation and actions taken varied between the four units and there appears to no absolute standard in place. Medication management on three of the four units was assessed. The following areas require attention: • • All administration of medication must be signed for or a code to explain why the medication was not administered. One resident is given covert medication, a letter from the GP was seen, and there is no corresponding care plan or indication on Medication Administration Records in what way this is to be done. The home must develop clear guidance in the way that medication is to be disguised. On one unit the trolley is left unattended while the medication is administered. The staff must ensure that the trolley is locked or a member of staff is present to watch the trolley. All medication must have a suitable label with the resident’s name. Date dispensed with the route and quantity to be administered clearly visible. Hand washing facilities for staff administering medication must be available. Policy and procedure must be developed for the new method of disposal of medication. On one unit the staff had altered the label on the medication for a resident, this is poor practice and must cease. The rooms that the medication is stored in must be monitored to ensure that it does not rise above 25OC. It is good practice to have a photograph of the resident with the medication Administration records to aid identification. • • • • • • • Staff working in the residential units have received medication Administration Training and this is ongoing. The storage and management of controlled medication meets with the Controlled Drug Act and guidance. During discussion it became apparent that some of the tenants living in the sheltered accommodation are assisted to have a bath on the residential unit, by care staff allocated to this unit. This is poor practice as the tenants are using facilities not allocated to them, and staff who are designated to meet the needs of the residents on this unit are distracted from their intended role. This was discussed with the manager and alternative arrangements must be made. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12 was assessed Residents find the lifestyle in the home matches their expectations and preferences, satisfying their social, cultural religious and recreational interests and needs. EVIDENCE: The social and recreational activities vary on the different units reflecting the needs and capabilities of the residents. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 14 It was noted during the time spent on the Dementia Care unit that the staff carried out various one to one activities and small group activities with the residents such as looking at news papers and magazines, spending time in the multi-sensory room, reminiscing and one to one discussions. Staff spoken to were aware of the abilities of the residents and their likes and dislikes. On the younger persons unit there were various activities to suit the needs and desires of the residents. Specific therapeutic activities were also available such as hydrotherapy and physiotherapy. The home has its own hydrotherapy pool that is maintained by the maintenance staff and used regularly during the week. Trips out are also organised using the home’s own transport and residents also go on trips with families and friends. The home is encouraged to maintain clear and concise records related to activities and the outcomes. This should be part of the care planning and evaluated monthly. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 were assessed Residents, their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Residents are protected from abuse. EVIDENCE: The home has received no complaints since the last inspection. The policies and procedures are appropriate and meet with current guidelines. Previous records were examined and the recording and information available was discussed and the following areas were explored. • • • The need to record the room number and unit on the forms to enable clear identification. To ensure that action taken and the outcomes are clearly recorded. The manager to sign all forms indicating that she has seen them and is satisfied with the actions taken. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 16 The manager has recently attended management training in adult protection and local procedures. She has planned to spend time with the staff passing on the most recent information related to this area and to ensure that all staff are aware of their role in protecting vulnerable adults. The home has recently had an allegation of abuse and the records seen indicate that this was appropriately handled and those required were appropriately informed. The policies and procedures for the Protection of Vulnerable Adults, Dealing with Abuse and Dealing with verbal and physical aggression are available on each unit; these are being up dated and will be available in November 2005. The home manages some residents’ personal monies. Records are clear and monthly audits are conducted. Relatives are encouraged to take home valuable items that the resident does not wish to keep. Not all residents have a locked facility in their own rooms to keep personal items. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 24 & 25 were assessed The residents live in a safe, well-maintained environment that is in places homely. The residents’ live in safe, comfortable bedrooms with their own possessions around them increasing their sense of personal worth. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 18 EVIDENCE: Town Thorns is situated in the heart of the Warwickshire countryside and overlooks fields. The home has been purpose built with the original building being used for functions and staff accommodation. The residents’ accommodation consists of four distinct units and sheltered accommodation situated on the upper floors. The décor and condition of the fixtures and fittings is to a good standard and meets the needs of the residents in the home. The grounds are extensive and there are some secure gardens for the residents in the dementia care unit to minimise the risk of losing their way. The home has a program of maintenance and renewal of fabrics and furnishings and records are maintained. The building complies with the local fire service and environmental health. All residents have single occupancy rooms with en-suite bathrooms comprising a toilet and hand washbasin. Each unit has sufficient assisted bathrooms to meet the needs of the residents. It was noted that there are not locked facilities in each room and on the dementia care unit one bedroom had a variety of creams left out in the ensuite, this is poor practice and could result in harm or an incident. Bedrooms viewed had a variety of furniture some supplied by the home and other items personal to the resident, there was also evident other personal items such as photographs, electrical appliances and pictures. Residents spoken to were happy with their rooms and one resident was delighted to show the inspector her collection of family photographs and gifts received. The staff on the dementia care unit encourage families to produce a photo time line of the family showing the life of the resident which helps to orientate and discuss the resident’s life. The bedrooms contained sufficient furniture to meet the needs of the residents. There was no evidence in the residents’ files that an assessment against the minimum standards has been carried out and that furniture that is not supplied is done so for a reason. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 29 & 30 were assessed The number, training and skill mix of staff ensuring the care needs and safety of the residents is met. Residents’ are supported and protect by the homes’ recruitment policies and procedures. EVIDENCE: From observation, discussion and records it was found that the home employ sufficient staff to meet the needs of the residents. There are qualified nurses employed to manage the nursing unit and senior care staff for the residential units. From the duty rosters it was noted that the home use agency staff at present to fill in duties not met by permanently employed staff. The manager informed that there was an employment campaign at present and they were hoping to reduce this to emergencies only thus ensuring consistency of care. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 20 There is designated staff to clean the home, carry out laundry duties and for the kitchen. Care staff do not carryout any of these duties. All staff have completed an induction program ensuring that they are all aware of the philosophy of the home and care practices that are required of them. Further training specific to their role is organised and evidence of this was seen in the staff profiles and supervision records viewed. Five staff files were examined and it was found that the homes’ recruitment process is robust and no member of staff is offered employment without all the necessary checks being completed. This process reduces the risk to residents. Overseas staff files were also viewed and these had the necessary documentation from the department of employment and immigration ensuring that the staff were legal employed. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 35 & 36 Residents’ live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge their duties and responsibilities fully protection those who the home cares for. Residents’ financial interests are safeguarded and protected from financial abuse. Care staff a suitably supervised ensuring safe working practices and support. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 22 EVIDENCE: The manager commenced employment at the home in July this year and has recently been registered with the Commission of Social Care Inspection. The manager is aware of the areas that require change and adjustments that were found during this inspection and has begun addressing these. The manager is suitably qualified and has completed the National Vocational Qualification level IV in Management. She has also completed training in Dementia Awareness and has the Chartered Institute of Management qualification. She has also obtained her licensee to manage the conference room and serve alcohol. Residents and their families are encouraged to manage their own finances and the home does not act on behalf of any resident. Some personal monies are maintained by the home and suitable records were seen containing running records and receipts of deposits and withdrawals to the individual accounts. The accumulative monies are maintained in a single non-interest account and these records were examined. The policies and procedures were seen and these require some changes to bring them in to line with current practice, it was informed that these will be available in November 2005. One resident in the younger persons’ unit manages their own bank account and finances with the assistance of the administrative staff. Policies and procedures regarding this should be made available. Information related to the management of personal allowance is available in the Residents’ Guide. All care staff and qualified nurses receive supervision six times a year and the records were seen in the individual staff files examined. All areas related to work processes, philosophy of care and training needs and achievements were covered. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 X 4 X 5 3 6 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 3 25 2 26 X STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 X 34 X 35 3 36 3 37 X 38 X Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? Yes (*) 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 OP7 Regulation 15 S 3(1)(b) Timescale for action (*) The registered manager must 30/11/05 ensure that there are suitable care plans available for all assessed needs of the residents and that there is consistency in recording these in all four units. (*) The registered manager must 30/11/05 ensure that all residents are risk assessed for nutrition, pressure damage and falls and where a risk is found a suitable preventative care plan is made available. The registered manager must 30/11/05 ensure that all residents are weighted at least monthly, records must be maintained clearly stating weight gain or loss and evidence that care plans have been devised. The registered manager must make alternative arrangements to meet the needs of the tenants in the sheltered accommodation. These needs must be met by the domiciliary care services. DS0000004324.V250905.R01.S.doc Requirement 2 OP8 14, 7 S. 3(3)(m) 3 OP8 14 17 S. 3(3)(m) 4 OP27OP8 18, 13, 14, 15 31/10/05 Town Thorns Version 5.0 Page 25 5 OP9 17 13 S. 3(3)(i) The registered manager must ensure that the management of medication meets with relevant requirements and guidance: • Ensure that all Medication Administration Records are completed at the time of administering the medication. Ensure that all medication is labelled. Ensure that staff do not alter labels on medication. Care plans must be written for the administering of covert medication. Policies and procedures for the new method of disposal of medication must be made available to all units in the home. The medicine trolleys must not be left unattended when open. 31/10/05 • • • • • 6 OP15 13 The registered manager must ensure that the kitchenettes are in good condition: The Dementia Care Unit area requires a new work surface, new flooring and new fridge. 30/11/05 Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 26 7 OP18 12 13 17 S.3 The registered provider must ensure that there are up dated policies and procedures concerning the management and recognition of abuse. The following must be available: • • • • • Signs of Abuse Managing allegations and suspicions of abuse Whistle blowing policy Dealing with verbal and/or physical aggression for residents. Role under POVA for all staff. 31/12/05 8 OP25 12 13 23 12 18 The registered manager must ensure that all residents’ rooms have a locked facility for personal use. 30/11/05 9 OP30 (*) The registered manager must 31/12/05 ensure that all staff receive specific training for their own specialist areas such as dementia care and learning disability. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 27 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 OP9 Good Practice Recommendations It is recommended that a photograph of each resident is made available in the Medication Administration records for ease of identification. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Town Thorns DS0000004324.V250905.R01.S.doc Version 5.0 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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