Inspection on 22/01/07 for Town Thorns

This inspection was carried out on 22nd January 2007.

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 23/02/06

Town Thorns 16/09/05

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 Jean Thomas Unannounced Inspection 22nd January 2007 09:30 X10029.doc Version 1.40 Page 1 SERVICE INFORMATION Name of service Town Thorns Address Brinklow Road Easenhall Rugby Warwickshire CV23 0JE 01788 833311 01788 833379 helen.owen@ben.org.uk 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) DS0000004324.V327734.R01.S.doc Version 5.2 Page 2 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. 23rd February 2006 Date of last inspection Brief Description of the Service: Town Thorns is a 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 primarily 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. The manager has advised on January 22nd 2007 that the current fees for a place in the home are as follows: Full Nursing Care from £665.00 - £700.00 and Residential Care £410.00 - £610.00. The cost of hairdresser, chiropody, toiletries, newspapers and magazines are not included in the fees. DS0000004324.V327734.R01.S.doc Version 5.2 Page 3 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This was a key unannounced inspection visit carried out by two inspectors. The inspection took place on Monday January 22nd 2007, commencing at 09:30am and concluding at 6:30pm. A key inspection addresses all essential aspects of operating a care home and seeks to establish evidence showing continued safety and positive outcomes for service users. Inspectors had the opportunity to meet a significant number of service users and talked to five of them about their experience of the home. Service users were able to express their opinion of the service they received to inspectors and conversation was held with other service users. Some of the service users found it difficult to engage in conversation due to their medical condition but were able to express their feelings with verbal and non-verbal communication. A number of service users required specialist dementia care and it was difficult to talk to them, but observations enabled inspectors to gain a better understanding of how the needs of service users with dementia were being met. General conversation was held with other service users along with observation of working practices and staff interaction with the people living in the home. During the visit, records and documents were examined and an opportunity was taken to tour the premises. Two relatives, nine staff members and the manager were spoken to and at the end of the inspection; feedback was given to both the manager and the unit manager. 28 questionnaire surveys were sent to service users and their relatives. At the time of writing the report, 21 service users and four relatives had responded. An audit of service users’ surveys show general satisfaction with the service provided. For example, the home is always fresh and clean and staff are available when they need them. Most service users indicate they receive the care and support they need and staff act and listen on what they say. A significant number of these comment cards had been completed by someone representing the service user. An audit of relatives’ comment cards also shows general satisfaction with the service provided. Comments include; “I think that Town Thorns is very very good, no urine smells etc very clean. I think all care homes should be like it”. “Would be nice if there was a volunteers system for people who could visit DS0000004324.V327734.R01.S.doc Version 5.2 Page 4 people who are bedridden and do not have many visitors. It can be very lonely in a room on your own 24 hours a day. Since the last inspection visit, there have been two allegations of theft from service users and one allegation of rough handling by a care worker. The allegations of theft are under Police investigation and the allegation of rough handling was referred to Social Services for investigation and in accordance with the local arrangements for the Protection of Vulnerable Adults (PoVA). Following investigation the allegation was partially upheld and the worker no longer works at the home. We were informed by the home that an internal audit showed that a number of medicines were identified as missing. The Police were informed and the whereabouts of these medicines remains unknown and we have been informed by the home that there have been no further incidents of medicines going missing. The organisation continues to provide personal care to tenants living in sheltered accommodation at Town Thorns even though they are not registered to do so. The organisation must submit an application for registration to the Commission for Social Care Inspection (CSCI) and in accordance with the Care Standards Act 2000 (part two) section 11). Outcomes for older people and younger adults were measured against different sets of National Minimum Standards. The inspection visit showed older people generally experience more positive outcomes than the younger adults living in this home and where a greater number of shortfalls were identified. The registered manager was present during the inspection and cooperated fully with the inspection process. The inspectors would like to thank service users, staff and relatives for their hospitality and cooperation during the inspection visit. What the service does well: The home offers a comfortable, attractive, clean and well-maintained environment for people to live in. Service users said that they felt well cared for and they had everything they needed in their rooms, which were kept clean and tidy. Service users who access the day care provision are able to participate in a wide variety of activities with staff support is necessary. Food is prepared safely, well presented and people have a good choice at mealtimes. The environment is generally warm and welcoming and visitors are made to feel welcome. There is space for people to move safely and people are able to access all shared areas of the home freely. DS0000004324.V327734.R01.S.doc Version 5.2 Page 5 Service users have regular access to physiotherapy and opportunity to participate in a range of daily social and therapeutic activities both in the home and in the community. What has improved since the last inspection? What they could do better: The manager must review the service provision for younger adults in the home to ensure that the National Minimum Standards for the younger people living in this home are being achieved. The review should look at the skills needed for a staff team involved in supporting younger adults to live ordinary and meaningful lives and to participate in and contribute to the community where they live through the care planning process. Health and Safety management must be improved to make sure fire safety procedures are followed and staff adopt safe moving and handling methods when assisting service users to transfer and products containing chemicals must be held safely and securely when left unsupervised. The people living in this home are concerned that their views were not sought in the changes taking place for the lunchtime meal provision. The manager must look at providing more opportunity for people to be involved in any major changes in the service provision as well as everyday choices. Management must develop an atmosphere of openness and respect in the home so that service users can feel confident that their views will be listened to and acted upon. The bathroom facility on the younger adult’s unit must be looked at and arrangements put in place that will promote the dignity and respect of the people for whom it is intended. Staff should be regularly supervised and their practices monitored so that the home can be sure all staff provide a good standard of care. We were advised that since November 2005 the home has recruited 42 new members of staff which indicates a high staff turnover and may mean service users do not always have opportunity to develop relationships with staff and which could lead to a lack of continuity in the care and support provided to service users. Management should consider introducing a staff retention policy DS0000004324.V327734.R01.S.doc Version 5.2 Page 6 aimed at retaining good staff so that service users benefit from having their care needs met by people they know and who are familiar with their needs and circumstances. Medication is not always being well managed and although management undertake monthly audits the inspection identified some discrepancies in the administration and recording of medicines. Management must make sure complaints are taken seriously and acted upon so that service users and their relatives are confident that any concerns are responded to appropriately. The homes policies and procedures do not safeguard the finances of people living on the Younger Adults Unit and must therefore be revised so that the home can be sure service users are not placed at risk. 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. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 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.V327734.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 Older People 2 Adults Quality in this outcome area is adequate. Older people contemplating moving into this home have all the information they need to determine whether the home is suitable for their needs but younger adults may not be aware of the impact that day care services may have on their lifestyle. Prospective service users have their needs assessed before they move into the home and sufficient information is recorded to ensure that a care plan can be developed. Standard 6 is not included in this judgement, as the home does not provide intermediate care. This judgement has been made using available evidence including a visit to this service. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 9 EVIDENCE: The home s Statement of Purpose was last updated in April 2006 and further amendments to the document are required to include the arrangements for the provision of day-care services at the home. Two service users living on the younger adults’ unit had a copy of the Service User Guide for the home and although this contained sufficient information about the care provision, there was a lack of important information for a younger adult with physical disabilities. For example, there was no information about people coming to the home to attend the day care service and that these people would be having their lunch in the communal lounge. Information held on 17 of the 21 service user comment cards completed shows that service users feel they had enough information about this home before they moved in and indicate they have been given a contract. It is the home’s procedure that a nurse from the home visits prospective service users before they are admitted to the home to assess their needs. The home has developed a pre-printed form to record information gathered during the assessment process. A copy of the initial care needs assessment is held on the service user’s care plan file and the information used to form the basis of a care plan. One visitor spoken with said someone from the home had visited their relative to discuss their care needs before they moved into the home. Inspectors examined the case files of three service users for evidence of the pre-admission assessment. Two of these service users were older people and one a younger adult. One of the two case files belonging to an older person contained a pre-admission assessment carried out by a nurse from the home that documented sufficient information to develop a plan of care for these individuals. One case file did not hold a pre-admission assessment. A staff member spoken with said that this service user had been at Town Thorns for a number of years and it was thought that the pre-admission assessment document had been archived. Pre admission information was also provided by professional health and social care agencies and generally used to inform care planning. Examination of a case file belonging to a younger adult showed that a full assessment had taken place to identify the individuals needs relating to health care, personal care and their specific care needs relating to their physical disability. Any potential risk to the service user when meeting their personal and health care needs had been identified and strategies put in place to Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 10 minimise the risk. There was no evidence to suggest that the views of the service user had been sought and agreed during the assessment process. The service user said they were happy about some of the risk assessments in place; for example, bed rails had been assessed as necessary to prevent the service user from falling out of bed during an epileptic seizure. The service user fully understood the reasons for this and said that they felt safer with the bed rails in place. It would be considered good practice if the service user’s agreement and understanding of the risk assessment had been recorded on the care plan. The manager talked about the initial care assessment process and said that a pre-admission assessment had not been carried out for a tenant in sheltered accommodation at Town Thorns as the tenant was already receiving personal care from staff at the home and who are therefore already aware of the individuals needs. An initial care needs assessment and risk assessment must be carried out for all prospective service users before they move into the home so that the home can be sure individual needs can be met and action taken to reduce any risks identified. Staff employed at the home should not be providing personal care for tenants in the sheltered accommodation as this type of support can only be provided by a registered domiciliary care agency. The registered person must therefore submit an application to the Commission for Social Care Inspection (CSCI) to register the service as failure to do so may result in legal action being taken against the provider. There was evidence in the case files of service users that they are provided with a contract informing them of their rights and responsibilities. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 12 Older People 7,8,9 and 10 Adults 6,9,16,18 19 and 20 Quality in this outcome area is adequate. Care planning in most cases includes the information necessary to plan the service user’s care and includes risk assessment elements. Care planning for younger adults does not promote or support service users to have the right to be in control of their own life and make their own choices and decisions. Service users have access to a range of health care services. Medication is not always well managed and therefore service users cannot be sure they will receive their medicine as prescribed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the care files in the home have a standard ‘layout’ and are methodically structured in a way that allow staff easy access to information about each service user. Each service user has a care plan that includes some of the information secured during the initial care needs assessments. The case files of three people with different primary care needs; older people nursing care, older people residential care and a younger adult with a physical disability and were examined and showed that each service user had a care plan, daily recording records and monitoring records. Care plans for older people were generally based on information secured during the initial care needs assessment and had been developed as staff got to know the service user’s strengths and limitations. Care plans held a range of information including nutritional needs, personal care needs, health care needs and interventions but did not always include sufficient detail of physical and mental capacities, necessary to promote and maintain independence. For example, one care plan includes support of “one carer to assist to wash and dress” but failed to identify what if any aspects of this task the service user can carry out independently. An evaluation of the care plan for each identified need is documented each month and the care plan revised following a change in need or circumstance. The home uses risk assessment tools to identify each service user’s risk of falls, developing pressure sores and risk of poor nutrition. These risk assessments are also reviewed and evaluated each month and are crossreferenced to care plans. There was evidence that staff sometimes fail to use Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 13 the information held on the care plan to inform practice. For example, during the inspection, one service user was not moved properly into a seat demonstrating poor moving and handling techniques carried out by care staff. Safe methods of moving and handling were discussed with the staff involved who said they had attended training and were aware that the methods they were using were not appropriate. Information held on one service user’s care file identified the service user as having ‘challenging behaviour and at being at risk of leaving her room unsupervised at night. In response a call alarm was fitted to the door so that night staff were alerted when the service user left their room unsupervised. Two staff spoken with said they familiarised themselves with service user’s care plans and gave an outline of how a service user’s care needs were being met. Staff members also expressed some concerns and said they felt that they were not given sufficient information during the handover between shifts as the time allocated for this activity had been reduced. Inspectors were informed that seven out of the 18 older people on the nursing care unit were on nutritional monitoring charts as there were concerns that their nutritional needs were not being met and service users were showing weight loss. Staff spoken to said the weighing scales used to monitor service users weight were not reliable and failed to provide accurate information necessary to determine whether nutritional needs are being met. The registered person must take action to make sure appropriate equipment is made available so that staff have access to the information they need to make sure service users needs are being met. Other issues raised by staff include concerns that service users are not always given sufficient food at breakfast. Examples given include: when one named worker is on duty twice as much food is returned to the kitchen, trays are removed from service users before they have finished their food and service users do not always get the support and encouragement they need to eat their food. Staff felt this might affect those service users who are losing weight. The registered person must look into the issues raised in this report and take appropriate action to ensure service users nutritional needs are being met. The care plan for a younger adult living in the home was looked at to determine that health, personal and social care needs were clearly set out in their plan of care. The service users views were sought regarding their care and the views of staff on duty at the time of the care planning process was discussed with them. There was evidence to suggest that specialist services, advice and guidance is being sought in the care planning process for continence support, epilepsy management and dieticians support. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 14 Care planning for younger adults however is in the same style as that for older people using the service and therefore is not assessing lifestyle wishes, aims or objectives for younger adults or identifying how independence can be maintained and promoted. Younger adults living in the home may not be getting prompt referral to specialist services for assessment of needs. For example, a record in the communication book for staff informed them to double pad XXX, using a yellow and white pad. A staff member on duty was asked about this instruction and whether this had been advised through the assessment process involving continence nurses. The staff member said that an assessment had not taken place. When they were asked about the arrangements for the supply of the continence aids being used, the staff member said that another service users supply was being used. The staff member was asked why the continence aids being used and said, Because the service user has refused to wear a catheter. This suggests that people are not receiving the support and advice necessary for good continence management that promotes independence. The weight record on the care plan looked at recorded a decrease in weight from January 2006 until September 2006. On the service user’s daily record chart in October an entry states that XXX has a reduced appetite at the moment, they may lose weight and become unwell, we will review when results of current investigation are received. There were no further records relating to the service users weight, or the outcome of the investigation, nor was there any care plan to meet changed needs. A staff member found a separate record of the service user’s weight, which showed that this had been monitored in November and December 2006. The record was not in kilograms, as on the original record, but in imperial weight measurement and indicated that a weight gain had taken place. Using two separate measurement systems is not recommended as conversion from one system to the other cannot be guaranteed and not all staff are able to do this with confidence. Evidence was seen that service users have access to doctors, speech and language therapists, dentist, opticians and chiropodist. Service users are registered with local surgeries and receive health-care support services as required. The home employ a physiotherapist and service users have access to therapy as and when required or requested. Comments on one service user’s survey include: the doctor visits the home twice a week I enjoy going to therapy there are a lot of things that could be done better and just changed doctors and it seems to be better. One visitor spoken with said the home had provided transport for their relative when they needed to visit the dentist. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 15 Service users requiring specialist equipment such as a pressure relieving mattress, cushion or hospital type bed have their needs assessed by a nurse or physiotherapist and the home provides any equipment deemed as necessary for promoting the health and welfare of service users. Inspectors were informed that at the time of the visit no one was being treated for pressure wounds or receiving end of life care. A tour of the home showed that a number of service users have adjustable height beds supplied by the home. Moving and handling equipment including a hoist is available and used by staff to assist service users to transfer. A senior staff member on the residential care older peoples unit talked about the arrangements for managing medication and said an internal audit carried out the week before the inspection had found only minor discrepancies in procedures. The management and administration of medication was looked at on the nursing care and residential care units for older people. The inspection found that medication was held securely and administered by nurses and designated care staff that have undertaken accredited training in the safe handling of medication. An audit of medication on the unit providing nursing care found a number of discrepancies in the administration and recording of medication and showed that medication was not always administered as prescribed. For example, Medication Administration Records showed there should be 21 Fluoxetine tablets left to administer and not 25 as was held and there should have been 22 Aricept tablets left to administer and not 26 as seen. Records also show that Paracetamol tablets administered to one service user four times a day failed to identify how many tablets were administered therefore practices are unsafe. The clinical nurse manager talked about the arrangements for managing medication and said that sometimes medication that has not been administered is carried forward to the next month and therefore the home cannot always be sure of the quantities of medication held. If medication is carried forward this would indicate that service users are not taking their medication as prescribed. Records seen show that very few service users refuse to take their medication it is therefore concluded that staff are signing medication records to indicate medication has been administered when it has not. Failure by staff to administer medication as prescribed is unsafe and place service users health, safety and welfare at risk. A number of controlled medications were held safely and securely and records show two signatures are obtained each time medication is administered. Records of Phentalyn patches prescribed for one service user were seen and the number of patches held corresponded with the number recorded in the controlled medicine book. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 16 Service users who have been assessed as being able to manage their own medicine have a lockable cabinet in their bedroom in which to keep their medicines safe. A designated fridge with a security lock fitted is used to hold medication requiring cooler storage temperatures. Fridge temperatures are monitored and recorded twice a day so that the home can be sure medication is held in accordance with the manufacturers instructions. The date of when eye drops were opened was recorded so that the home can be sure medication is not administered after the manufacturers used by date. Service users living on the younger adults unit said they felt happy in the home and appeared to be able to choose to be alone or join in an activity if they wished. They said they had a key to their room and staff were seen to knock on doors before entering. Service users looked smart and had the equipment necessary to support their independence although care plans do not reflect an ethos of promoting and maintaining independence but rather focus on what the service user cannot do. There is a key worker system in place and positive relationships were observed between service users and staff on duty at the time. Older people living in the home appeared well cared for and staff were seen to be treating them with respect and dignity. Two staff members talked about the arrangements for promoting and maintaining service users’ privacy and dignity, which included consultations with health care professionals and treatments in the privacy of the service users’ own room. Service users spoken to confirm this occurred and said, “permanent staff are kind and helpful” and the agency staff we used to have were not very good but staff from the new agency seem better a visiting relative spoken to described staff as “kind and caring” and was satisfied with the standard of care provided to his relative. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Older People 12,13,14 and 15 Adults 12,13,15 and 17 Quality in this outcome area is adequate Care planning is not supporting younger adults to enjoy a full and stimulating lifestyle other than in house day care services that suit all age ranges. There is little opportunity for service users to be involved in the day-to-day running of the home and to contribute to the development of the service. Service users are given the opportunity to take part in a variety of activities both within the home and in the community. Service users are offered a varied and nutritious diet. This judgement has been made using available evidence including a visit to this service. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 18 EVIDENCE: The home has an open visiting policy that takes into account the individual needs and wishes of service users. Service users said they are able to have visitors and maintain contact with family members although one service user said that their finances and transport availability restricts the frequency of visits home to see their ageing relative. Service users were seen receiving visitors in the privacy of their own room or in communal areas of the home. One visitor spoken to said they usually visits at mealtimes so that they could “feed” their relative. The home have a number of volunteers that provide therapy, drive the transport and run the league of friends shop. Service users were observed to spend time in the privacy of their own rooms or join other service users in communal areas for company, meals or activities. The home will organise occasional visiting entertainers and regular church services at the home. A new activities worker had been employed and was getting to know the service users and was involved in planning activities. Records of participation in activities are held but do not include the aim of the activity. Records showed that a number of service users regularly play bingo and attend a weekly exercise group organised by the ‘physiotherapy department’. Other activities provided include, weekly indoor bowls and a poetry afternoon. Painting, crafts and games including dominoes, cards, scrabble, quiz, crossword, and chess are also made available on a regular basis. Activities generally take place in the day service area. On the day of the visit, service users were enjoying bowling and crafts and quizzes in this area. One service user showed an inspector their artwork and talked about their plans to enter some paintings into a local art competition. Comments noted on one service user comment card include; “ Will be pleased to use the hydrotherapy pool again, as have not been able to use this facility since February”. Inspectors were informed that a new physiotherapist had been appointed and was waiting for appropriate hydrotherapy training so that service users can again benefit from participating in this popular activity. Observations on the dementia care unit found staff attending to service users needs in a sensitive and caring manner. One service user was seen knitting and another walking about. There was a relaxed atmosphere and staff were engaging service users. Transport for community arranged events are provided by the home and service users are asked to make a donation towards the cost. Trips out during Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 19 the last 12 months include; pantomimes at Dunchurch and Leamington Spa and other trips to the theatre, a day at the races and a visit to the West Midlands Safari Park. The hairdresser visits weekly and provides services at the home. The cost of hairdressing is not included in the fees and range from £5.50 - £18.50 depending on what is required. Lifestyle diaries are being developed and involve the service user and their relatives in producing a story about the service users life, highlighting important events from the point of view of the service user, and including some pictures and photographs where appropriate. This is done in ‘scrapbook style’ and can be as short or as long as the service user wishes. Relatives take the lead in developing the life story. One service user said, we are well looked after here but I get fed up as there’s not much to do. Observations on the older person’s care unit showed five service users sleeping in their chairs. On the nursing care unit for older people, service users are given the opportunity to rest on their bed in the afternoon. To enhance service user’s comfort this opportunity should be extended to service users on the older persons residential care unit. Shortfalls in care planning were identified; for example, the care plan for a younger adult failed to show that the views of the service user had been sought during the decision-making process, as there was no record made of this. For example there was no care plan in place about how the service user was to be supported to manage their finances and no agreement as to whether this should be the homes responsibility or the service users. The service user said that they have access to personal spending money, as they required it and they knew how to do this. They said, I go to reception and they give me my money when I want it. They said however that they did not receive information about their finances for example, monthly bank statements and said, It would be nice if I could. The receptionist holds records of income and outgoing payments for the service user. Although records were legible, they were not in sufficient detail to show where income had come from neither was there a clear audit trail of expenditure. For example, a diary entry on the service user’s care notes stated, got hundred pounds to get XXX new clothes and a Christmas tree. There was only an outgoing entry of £100 on the service user’s financial record and two people had signed this. Receipts had been returned to show that goods had been purchased however there was no record on the financial record of what had happened to any change there may have been. The person responsible for administration of service users personal finances said, generally the service user keeps this. Receipts are not numbered which would support an audit of Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 20 finances. Younger adults living in this home are not offered individual banking arrangements and this does not promote independence. Care planning for younger adults fails to include an assessment of lifestyle wishes, aims and objectives. One service user talked about their regular access into the local town for shopping and how they use the minibus or their mobility scooter to do so. Daily record seen suggested that service users do not have opportunity to access shops with staff support for clothes shopping but that staff are shopping for them. The care plan also failed to include service user’s choices about accessing colleges, distance learning programs or how they can continue to pursue activities they engaged in before entering the home. Staff members engaged service users and were patient and encouraging. At the time of the visit, all bedrooms were single occupancy to provide privacy for service users. Service users have no limitations placed on them and get up in the morning and retire when they choose. On the day of the inspection, service users generally looked well groomed and cared for. For example nails cut and clean, hair combed and male service users had been shaved. A tour of the premises found the kitchen was clean and well managed. Store cupboards were stocked with a wide range of provisions including fresh fruit. The cook talked about the arrangements for cleaning the kitchen and said there was a cleaning schedule in place and used to make sure all areas of the kitchen are routinely cleaned. Menus were displayed in the kitchen and showed a varied and nutritious diet that offered alternatives. Specialist dietary needs can be catered for and include diabetic, soft and liquidised meals all of which were attractively presented. An inspector joined service users for lunch on the older peoples nursing care unit. Lunch is transported from the kitchen to each unit in a hot trolley where it is served by the staff. On the day of the visit, service users were offered beef stew, fish pie served with potatoes, carrots and peas or cheese salad. Followed by fruit crumble and custard. Food was nutritious, attractive and well cooked. The practice of serving hot food on cold plates is not seen as good practice as the food may be cold before service users finish their meal. It is therefore recommended that warm plates be used when serving hot food. Staff were generally aware of service users’ needs and were attentive towards them. One carer was not aware of the dietary needs of a service user she was feeding but the staff plating up the meals were aware that the service user required a diabetic diet and offered food that had been specially prepared by the kitchen. Observations of the lunchtime meal showed that service users were able to make choices about the meals they wish to eat. There was a calm atmosphere Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 21 in the dining areas and some service users sat at tables while others had their meal in their room. Staff were available to assist the service users should they require help and a number of service users were supported to eat their food. One service user was asleep at the dining table and after a short period was assisted back to an armchair without having first been encouraged to eat any food. At the teatime meal, however this same service user was encouraged and supported by a carer to eat her teatime meal. Entries in the daily records completed by staff initially showed that the service user ate all her food at lunchtime and the entry was later crossed out. There was no evidence that the service user was encouraged to eat her main meal or that the meal was offered later in the day. After meals, care staff wash the dishes in the kitchenettes on each of the units. On the older persons nursing, care unit the dishwasher was ‘out of order’ and a staff member said that the machine had not been operating since October 2006 and since that, time care staff have hand washed the dishes. Staff members said, The home cant afford to repair the machine and resident’s family offered to buy a new one. The registered person must either make sure suitable equipment is available or consult with the Environmental Health Officer (EHO) to make sure staff practices are safe. The additional staff time spent carrying out what are known as secondary tasks may leave service users without the care and support they need and place them at risk. Changes have been introduced so that service users now have the main meal of the day at lunchtime instead of in the evening. The decision to alter the mealtime arrangements is a cause for concern for service users. Service users asked if we would tell them why this had happened. They had not been consulted about the change saying, I didnt know until a carer said and I would hope we are asked about meals and we had no meeting. The manager said changes at meal times were introduced because this was reported as being of benefit to service users. The manager said that meetings had taken place but there were no records to support this or to show that the views of service users in the decision-making had been taken into account as part of the planning of the trial period. The impact for individual service users during the trial period had not been considered and two service users spoken with had concerns about this. They said I have to go out into town now to buy a pasty, as I only like a snack at lunchtime. and I have been told I cannot have a dinner saved for me so that I can reheat this in my microwave in the evening. Service users spoken to said the food was good and confirmed they were always offered alternatives. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 22 Comments noted on service users’ comment cards include: • Don’t like spicy food. Lumpy potatoes sometimes need to be mashed better. • Food is quite good and I have a choice each day”. • Food is satisfactory, but find the helping far too big”. • “I would like to see them presented better. • I think the menus could be arranged better, too much of a repetition. The inspection found that service users could choose how and where to spend their time and do not have any restrictions imposed on them. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Older People 16 and 18 Adults 22 and 23 Quality in this outcome area is adequate Some people using this service feel they do not have opportunity to express their concerns and are not confident that these would be listened to and acted on. Training of staff in the area of protection is regularly arranged by the home and this is keeping people living there safe from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information supplied to the commission before the inspection visit show that since last inspection, the home had received four complaints and following investigation one complaint was substantiated, one partially substantiated and two are awaiting an outcome. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 24 Since the last inspection visit, there have been two allegations of theft from service users and one allegation of the rough handling of a service user by a care worker. The allegations of theft are under Police investigation and the allegation of rough handling was referred to Social Services for investigation and in accordance with the local arrangements for the Protection of Vulnerable Adults (PoVA). Following an investigation the allegation was partially upheld and the worker no longer works at the home. We were also informed by the home that an internal audit showed that a number of medicines were identified as missing. The Police were informed and the whereabouts of these medicines remains unknown. Four service users spoken with were not fully aware of the complaints procedure and one was not confident that their views would be taken seriously saying in relation to the change of mealtimes, how can one person make a complaint. Another service user said of the complaints procedure, I am not quite sure who I would talk to - the nurse or manager. Staff spoken to on the younger adults unit were unclear about where the record of complaints were held and said they did not have a process for recording complaints. Comment cards received from two relatives show they do not know who to complain to. An audit of service users’ comment cards shows that most service users would talk to a member of staff and usually the ‘care manager’ or would go to the office should they wish to complain. Additional comments include: I would have to ask somebody who to speak to and under the new matron, she listens, but doesnt seem to act on anything you say. One service user spoken to said she would speak to the nurse if she were unhappy with any aspect of the service and also said she had never had cause to complain but felt unhappy that the time of the main meal had changed from tea time to midday and she didnt know why this had happened. The last inspection identified gaps in staff training in Adult Protection resulting in a requirement that staff attend appropriate training. In response, staff have recently participated in a rolling programme of training in the Protection of Vulnerable Adults, (PoVA). This training has been reviewed and will in future include the No Secrets, policy and the newly introduced Vulnerable Adults workbook introduced by the Warwickshire Quality Partnership Board and the Warwickshire Social Services PoVA Liaison Officer. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 25 Staff attending PoVA training are also expected to complete an assignment to determine that knowledge learnt was satisfactory. This is good practice and will be supported in assessing further training needs within POVA understanding, for example, the ‘whistle blowing’ policy and procedure. Discussions with staff on duty demonstrated they have a good knowledge base and understanding of issues related to preventing and handling concerns related to the protection of vulnerable adults and were aware of the ‘Whistle blowing’ policy and procedure and said they would report any concerns to the manager. Staff said service users “are well cared for” and have their rights respected. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): Older People 19,21,22,23,24 and 26 Adults 24 and 30 Quality in this outcome area is good. The service provides a homely environment that is clean and well maintained that is suited to their needs. There are sufficient facilities to meet the needs of service users who are encouraged to personalise their rooms. The home has appropriate systems in place to reduce the risk of infection. This judgement has been made using available evidence including a visit to this service. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 27 EVIDENCE: Town Thorns is situated in the heart of the Warwickshire countryside and overlooks fields. The gardens/grounds cover an area of 20 acres and are well maintained, attractive and accessible. There are some secure gardens designed specifically for service users in the dementia care unit to minimise the risk of losing their way. The home has been purpose-built with the original building being used for functions and staff accommodation. The service users accommodation consists of four distinct units and sheltered accommodation situated on the upper floors. The home is decorated and maintained to a good standard and meets the needs of service users. A tour of the premises found the environment was well maintained. All areas of the home seen were clean, bright and airy and free of offensive odours. There are 58 single bedrooms 54 of which have ensuite facilities and four double bedrooms with ensuite facilities. At the time of the inspection visit, none of the service users were sharing a room. Each unit has sufficient numbers of assisted bathrooms to meet the needs of the service users. Five service users were happy for inspectors to view their bedrooms, which were of a reasonable size and accessible for wheelchairs. Service users are encouraged to personalise their rooms and some had brought small items of furniture in with them. Service users spoken to said they were satisfied with their accommodation and were very comfortable. Rooms held a range of personal items including an armchair, photographs, ornaments, flowers and pictures hanging on the wall. Most bedrooms have a locked drawer in which to hold medication, (if the service user wished to self medicate on completion of the necessary risk assessment), or money if they chose to manage their finances. Rooms visited included two belonging to service users on the younger adults unit. Each bedroom was clean and reflected the individual interests and hobbies of the service user. One service user’s bedroom carpet however had faded from the sunlight and the area of the carpet by their bed was badly stained. The service user said that the carpet is shampooed regularly however if the carpet were to be replaced this would provide the service user with a more welcoming environment. On the younger adult unit, there is a shared kitchenette, where service users can make snacks and light meals for themselves. The kitchen has low working surfaces that meet the needs of people who use wheelchairs. One service user said that they use this area most mornings for making their breakfast. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 28 The dining and lounge areas on this unit were clean and spacious providing a welcoming place for people to enjoy their meals and relax in. A tour of the younger adult unit showed that staff used the bathroom for storing their outdoor clothes and other belongings, two shower trolleys were also stored and two holdalls belonging to staff had been left in the bath. Using the room and bath for storage of outdoor clothing and baggage and for storing equipment does not promote the management of infection control. It also suggests that the promotion of dignity for service users, when bathing, may not be respected as staff could use the room to access their belongings when a service user was using the room for personal care. The entrance to the bathroom is off small corridor that leads to the sluice room. There was a linen trolley in this corridor and the sluice room door was open. The approach to the bathroom provides limited access for wheelchair users and is unwelcoming The manager is keen to improve the bathroom facility on the younger adult unit and said they had requested an alteration to the room to improve the access. Alternative facilities for staff clothing and belongings must also be identified and used so that services users’ privacy is not at risk of being compromised. A tour of the premises found that adaptations and equipment was available to meet the assessed needs of the service users and include handrails fitted along the corridors, grab rails in the toilets, access ramps and a passenger lift for wheelchair users. A call alarm system is in place but not all service users have easy and safe access (refer to standard 38). Laundry facilities were inspected and found to be well organised, clean and hygienic. Soiled laundry was held separately in red bags and washed at the appropriate hot water temperatures to ensure it was thoroughly clean and to control the risk of infection. Hand washing facilities and disposable gloves were available and the storage area for laundered linen and clothes were tidy and clean. When asked about the quality of the laundry service users said their clothes were usually returned promptly and they were satisfied with the service. Comments noted on quality assurance questionnaires distributed by the home include: jumpers tumble dried shrunk and laundry good but could be a little better some whites lose their colour. All the service users seen were generally smart in their appearance, with clothes generally looking fresh and clean. Staff were wearing suitable protective clothing when carrying out personal care tasks, health care treatments or when handling soiled laundry. Safe systems were in place for the safe management of domestic and clinical waste. Liquid soap and paper hand towels were available in the toilets and each floor had a Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 29 sluice facility used by staff to clean commodes. Observations on the older persons nursing care unit showed that alcohol based hand scrub is displayed on the wall outside each service users room with the exception of the dementia care unit (for safety reasons) for use by staff before entering service user’s rooms. Although staff training records show that not all staff are trained in the control and prevention of infection and some staff require updates. A new training strategy has been introduced that incorporates infection control and prevention into the staff induction programme. Training on infection control is now mandatory and will include updates. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 30 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. JUDGEMENT – we looked at outcomes for the following standard(s): Older People 27,28,29 and 30 Adults 32,34 and 35 Quality in this outcome area is good. Service users have confidence in the staff that care for them. The revised training and development programme should ensure staff receive relevant training that is targeted and focused on improving outcomes for service users. Rigorous staff recruitment policies and procedures serve to protect service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection visit the staff complement and number of service users accommodated was as follows: Younger adults unit (15 service users) Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 31 In the morning a nurse and four carers, in the afternoon and evening a nurse and three carers. At night, a nurse and a carer. Older people nursing care unit (18 service users) In the morning a nurse and six carers, in the afternoon and evening a nurse and four carers. At night, a nurse and two carers. Older people residential care unit (21 service users) In the morning the unit manager and four carers, in the afternoon and evening, three carers. An additional person is on duty on the residential care unit on the early and late shifts to provide a care service for people living in the sheltered housing. Dementia care unit (8 service users) Four carers cover the day and evening shift and two carers at night. Other staff on duty include: Physiotherapist, eight domestic assistants including two in the laundry, chef and two kitchen assistants, activities coordinator, two administrators and maintenance staff. Examination of four weeks staff rotas showed there appeared to be sufficient numbers of staff available to meet the assessed needs of service users and bank or agency staff were used to fill any gaps. Information supplied by the home and before the inspection visit shows that in an eight week period 349 shifts were covered by bank or agency staff. Comments on one service user’s survey include: staff in general are very helpful but commonplace shortages puts carers under pressure resulting in loss of attention at times with staff wishing to give more help. The remoteness of this rural care home is inevitably a reason for difficulty in securing staff. Many leave, possibly because of time and cost of travel. Information supplied to the commission by the home shows that since November 2005 26 staff have terminated their employment at the home. One service user said, They are sometimes short staffed like today when morning coffee should have been about 11 oclock and its now 11:40 and I havent had my morning drink. A staff member commented, staff are caring and committed but the staffing wasnt brilliant last year but its now much better. Other staff members said care could be better; there are some decent staff here but some only here for the money not for the care and staff practices not monitored too many agency staff seemed to be training them all the time. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 32 Comments noted on service users’ comment cards include: Administrative staff are clearly very busy at least most of the time, and in such circumstances I hold back from troubling them, being anxious not to be a nuisance” and I think positive lines of communication needs to be made clear too many agency staff. A number of service users spoken to said the home was often short staffed and expressed dissatisfaction with some agency workers” who were described as uncaring and abrupt. Staff spoken to described some agency staff as a bit rough in the way they handled service users and new agency is a lot better. Some of the staff spoken to said staff morale is very low and we raise concerns about staff who dont work and who dont seem to care about residents but nothing happens we have rules but some staff just do as they like. The manager talked about managing staff shortages and said dissatisfaction with some agency staff had resulted in a second and new agency also being used to supply cover for staff absence and feedback from service users and staff on the performance of these workers had been satisfactory. Inspectors were advised that a number of new staff have been employed and are awaiting the outcome of security checks before being confirmed in post. Since the last inspection, a designated person has been appointed and is responsible for the planning and development of the staff training programme. The training co-ordinator has a planned training programme for the coming year, which had been identified following a working party review process. There was evidence to suggest that the working party had consulted with the Skills for Care Council and the Warwickshire Quality Partnership Board when identifying a common induction programme and ongoing staff development. The working party had also looked at re-structuring the supervision and appraisal system. The draft document was examined and showed this to be compatible with the Care Home Regulations and National Minimum Standards. The training coordinator said that staff responsible for conducting supervision and appraisal had attended training in their role and responsibilities in October 2006. Progress of the implementation of the new structure will be looked at during future inspections. There is evidence that an active National Vocational Qualification (NVQ) programme is in place and this is being reviewed with all staff to ensure that support to achieve an NVQ in care is appropriate to individual needs. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 33 Records showed that 44 staff held a first aid certificate and other training attended includes; food hygiene, managing abusive behaviour, sexuality and relationships, wound care, dementia awareness and Parkinson’s disease. A number of staff have had only limited training and it is anticipated that the introduction of the new staff training strategy will address shortfalls. This will be looked at again during the next inspection visit. A staff member was asked about what they thought the service did well’ and their comments include: The care, we make sure things are done well, it is jolly here. and we make decisions on an individual basis through the key worker system. When asked what could be done better the staff member felt that supervision and appraisal could be improved on. Although there was sufficient numbers of staff on duty at the time of the visit to meet the personal care and mobility needs of the people on the younger adult unit staff were not seen to be spending social time with service users or planning activities with them that could happen in the lounge area. Service users appeared to access the day care activities for this, one service user did say, sometimes staff sit with me and we play cards. The recruitment files for three newly appointed staff were looked at and found to be in good order with clear evidence that appropriate checks had taken place prior to their coming to work in the home. Criminal Record Bureau checks had taken place and two written references had been obtained. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 34 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. JUDGEMENT – we looked at outcomes for the following standard(s): Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 35 Older People 31,32,33,35,36 and 38 Adults 37,39 and 42 Quality in this outcome area is poor Service users have the opportunity to manage their own money if they wish, and some facilities are provided to help keep it safe. Where the home manages money on service users behalf a system is in place to record transactions and accounts for spending. Health and safety concerns and a lack of confidence in management means that service users are not adequately protected and may feel unable to raise issues with management and which impact on their daily lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been at the home since July 2005 and is suitably qualified and has completed the National Vocational Qualification level IV in Management. She has also completed training in Dementia Awareness and is working towards completing the Chartered Institute of Management qualification. There are clear lines of responsibility and accountability within the organisation and within the home. Four directors support the responsible person and each take the lead on key areas. The lead clinical nurse, assistant matron and administrative staff support the manager. There are three unit managers’ working days and one-unit manager on duty at night. Through discussion with service users and staff, there was evidence to suggest that the service is not benefiting from a management ethos that creates an open, positive and inclusive atmosphere. For example, a service user spoken with had very little confidence that if they made a complaint this would be listened to and action taken to resolve their concern. Another service user was not sure who the manager was and said, I have never seen the manager. A staff member said that it would be nice for the manager to speak with residents on the units and socialise with them. All service users and staff spoken with had great concerns about the lack of consultation there had been between themselves and the manager over the introduction of the new mealtime arrangements. A number of staff said the manager does not always respond to issues they raise and felt it would be useful to hold regular staff meetings so that they could voice their views and opinions in a constructive manner and have their voices heard. Information supplied by the home shows that the manager holds Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 36 regular meetings with departmental heads but does not have regular meetings with staff. Regular meetings may encourage interaction and could contribute to creating a more positive relationship between staff and management. Staff spoken with said that currently they have a training needs appraisal twice a year but supervision is not regular. The manager has recently introduced an annual development plan for quality assurance that involves seeking the views and opinions of service users and family members via a questionnaire. At the time of the inspection visit a small number of questionnaires had been completed and returned comments noted include: Problem is we have to keep reiterating our issues, although not major ones its frustrating to keep having to remind carers about mums requirements. Cleanliness beautiful and meals very good excellent care at all times and quality of care and friendliness of staff in all cases either good or excellent. The manager talked about the quality audit and said she plans to use the outcomes to further improve services. The outcome of the quality audit will be looked at again during the next inspection. A notice inviting service users to attend ’service users meetings’ every two months was displayed in the passenger lift. Service users spoken to said they were unaware of any meetings taking place and the home was unable to provide any documentation to support these meetings take place. It is strongly recommended that service users meetings are introduced and used as a forum to seek service users’ views and opinions about the quality of the service and to inform and to consult on any proposed changes. Information supplied by the home and before the inspection visit shows that the manager does not act as appointee for any service users for their benefits or manage any savings. There is a record held of monies paid to the service users. This record is signed by the service user or if appropriate their key worker and witnessed by a second member of staff. A receipt is issued for monies held for safekeeping and a receipt retained for any items purchased on the service user’s behalf. None of the older people receiving a service manage their own finances. Some are managed with informal assistance from family members or through Power of Attorney or Guardianship arrangements. In response to a service user’s request, the service user has signed a letter of authorisation so that the home can give his personal allowance to his daughter. A tour of the premises identified a number of shortfalls relating to the health and safety of service users: • Fire doors leading into the kitchen and laundry room were wedged open. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 37 • • • Bottles of shampoo, deodorants and hairspray aerosols were left unsupervised and unsecured in bathrooms and in a linen cupboard and therefore placing service users at risk. Staff were adopting unsafe moving and handling methods when assisting a service user to transfer. Two service users being cared for in bed did not have easy and safe access to a call alarm. It was also a concern to see that a fire exit corridor on the younger adult unit was being used for storing two wheelchairs, an electric fan, bathing equipment and a wheelchair cushion. This would be a serious hazard in the event of the building having to be evacuated in an emergency. These issues were raised with the manager who took immediate action to promote and maintain safe working practices. We obtain information before inspections. The information includes confirmation that all necessary policies and procedures are in place and are upto-date. These are not inspected on the day but the information is used to help form a judgment as to whether the home has the correct policies to keep service users’ safe. The home employs maintenance staff responsible for carrying out repairs and routine maintenance checks. Temperature check, water-heating checks for compliance with legionella are carried out monthly. The fire alarm is tested weekly on a Monday morning and the most recent fire drill took place on October 6, 2006. The fire officer last visited the home on June 2, 2006 and no recommendations or requirements were made. We receive regular reports from a representative of the owners of the home under regulation 26 and timely notifications under regulation 37. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 38 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 2 22 2 23 3 24 3 25 X 26 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 1 33 2 34 X 35 3 36 1 37 X 38 1 Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 39 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4.1(b) Requirement Timescale for action 01/03/07 2. YA6 3. YA18 4. YA27 5. YA42 The registered person must ensure that the Statement of Purpose is very clear that people accessing the daily service from the community will be eating their lunch in the lounge of the residential home so that the people wishing to come and live there are aware of this. 15.1 The registered person must ensure that care plans for younger adults reflect the needs, aspiration and goals of the individual’s health and social care needs. 13.1(b) The registered person must ensure that service users only use continence aids that have been identified as appropriate to their needs and following an assessment by a continence adviser. 23.3(a)(j)(ii) The registered person must ensure that bathrooms used by service users are not used as a staff changing room or storage facilities. 23.4(a)(b) The registered person must ensure that fire doors are DS0000004324.V327734.R01.S.doc 01/03/07 15/02/07 31/01/07 23/01/07 Page 40 Town Thorns Version 5.2 6. OP8 16(2) 7. OP9 13(2) 8. OP14 12(3) 9. OP15 12(1) 10. OP15 13 11. OP22 13(4)(c) 12. OP32 12(5) 13. OP36 18(2) closed when not in use and fire escape routes not obstructed. The registered person must ensure suitable equipment including weighing scales are provided to monitor the weight of service users whose nutritional needs are giving cause for concern and Ensure staff have access to the information they need to meet service user’s care needs. The registered person must arrange for the handling, safekeeping and administration of medicines received into the care home. The registered person must make proper provision for the health and welfare of service users and so far as is practical ascertain and take into account their wishes and feelings. The registered person must promote and make proper provision for the health and welfare of service users so as to ensure nutritional needs are met. The registered person must ensure suitable facilities are in place for washing dishes and in the absence of a dish washing machine seek advice from the Environmental Health Officer to determine whether current practices are safe. The registered person must ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The registered person must maintain good personal and professional relationships with service users and staff. The registered person must DS0000004324.V327734.R01.S.doc 31/01/07 31/01/07 28/02/07 14/02/07 14/02/07 31/01/07 28/02/07 14/03/07 Page 41 Town Thorns Version 5.2 14. OP38 13(5) ensure staff are regularly supervised and practices monitored. The registered person must make suitable arrangements to provide a safe system for moving and handling service users and make sure all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. 31/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA2 YA7 Good Practice Recommendations Service users views on their assessed needs should be included on their assessment document. Financial records of service users personal finances should account for any monies not returned for safe keeping if the receipt from purchases is not compatible with the amount withdrawn. All receipts returned should be recorded in numeric order for auditing purposes. Service users, who are younger adults, should be able to manage their own finances with support and tuition provided as needed and the reasons for and manner of support should be documented and reviewed. The service should help service users who are younger adults to find out about and take up opportunity for further education and distance learning and discussed this with them during the care plan review. Weight monitoring records must be maintained clearly stating weight gain or loss in either metric or imperial measures and evidence that care plans have been devised. The carpet in the identified service users bedroom should be replaced to with new so the room is more bright and welcoming. Consideration should be given to providing another entrance to the bathroom facility on the younger adults unit so that access is easier for people with a disability. Staff working with younger adults should have a basic DS0000004324.V327734.R01.S.doc Version 5.2 Page 42 3. YA7 4. YA12 5. 6. 7. 8. YA19 YA26 YA27 YA32 Town Thorns 9. 10. 11. YA38 OP15 OP33 understanding of the National Minimum Standards for Younger Adults and how these should be reflected in care planning programmes. The manager should develop processes for enabling service users to feel valued and that their opinions matter. Staff should regularly consult with service users about the menus so that service users have an opportunity to contribute to menu planning. Service users should have the opportunity to attend regular meetings said that they can discuss issues that impact on their daily lives and have the opportunity to contribute to the management of the home. Town Thorns DS0000004324.V327734.R01.S.doc Version 5.2 Page 43 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.V327734.R01.S.doc Version 5.2 Page 44 - 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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