Care Home: Blackthorns

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What the care home does well Staff use a comprehensive pre-admission tool, which enables them from the information obtained to develop a care plan that is designed to meet the needs of the individual. Records sampled showed that people`s health care needs were well identified and a referral made to the appropriate professionals to ensure that their identified needs were well met. People are supported in an environment that is comfortable, clean and tidy and well maintained, in which they can maintain their independence. People are supported by a staff team who are trained and skilled to meet their assessed needs. People in the home benefit from being supported by a staff team who are manages by an experienced and competent manager, who provides them with a clear sense of leadership and direction. What has improved since the last inspection? The home`s care planning process has been improved so that the care plans now provide staff with the necessary level of information to enable them to meet people`s assessed needs. The home has undergone a complete programme of refurbishment and people spoken with said how much better the living environment was. A hearing loop system has been installed for the benefit of people who may have a hearing impairment. The home`s staffing level have been reviewed to ensure that there are always sufficient staff on duty to meet the assessed needs of the people living in the home. A registered manager has been appointed to have responsibility and accountability for the day to day running of the home. There is now a quality assurance system in place in the home which takes account of the views of people living in the home and other interested parties. What the care home could do better: No statutory requirements were made as a result of this inspection visit, however it is recommended that the home stop using the sluice facility has a storage area and seek a more appropriate place in which to store equipment. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Blackthorns 21-29 Dooley Road Halstead Essex CO9 1JW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Neal Cranmer     Date: 0 8 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Blackthorns 21-29 Dooley Road Halstead Essex CO9 1JW 01787472170 01787476342 blackthorns@runwoodhomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Runwood Homes Plc care home 62 Number of places (if applicable): Under 65 Over 65 0 62 dementia old age, not falling within any other category Additional conditions: 62 0 The maximum number of service users who can be accommodated is: 62 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - code OP. Dementia - Code DE. Date of last inspection Brief description of the care home Blackthorns is an established care home, which provides residential care for older people and older people with dementia. The home also provides accommodation for 5 people on a short-term respite basis. It is a large purpose-built property situated in a residential area of Halstead. There is registered accommodation for sixty-two people within four units. Since the last key inspection visit undertaken in May 2007 an appointment of registered manager has been made to the home. The home has a large lounge for all of the people living at the home and each of the Care Homes for Older People Page 4 of 26 Brief description of the care home four units has its own communal area. All accommodation is located at ground floor level. Blackthorns has a central courtyard garden with seating and a patio area and around the home there are gardens with flowerbeds and borders with further seating areas. Car parking is available at the side of the property. The current range of fees, as at the site visit were said to be £433.30 per week to £650.00 per week. Toiletries, newspapers, hairdressing and chiropody are an extra cost, this information was provided to us by the deputy manager during the key inspection visit undertaken on the 8/7/2009. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report follows a key unannounced inspection that was undertaken on the 8th of July 2009 and which lasted 7.45 hours. The report has been written using accumulated evidence gathered prior to and during the inspection visit, including the homes (AQAA) Annual Quality Self Assessnent, which is a legally required document that the manager uses to tell us what they do well and how they intend to improve further. This inspection included discussions with three people who live in the home, three relatives, the deputy manager and four members of the care team. A tour of the premises was undertaken during the course of the inspection, which included the viewing of peoples rooms with their consent, bath and toilet facilities and Care Homes for Older People Page 6 of 26 communal living areas. During the course of the inspection a range of documentary evidence was sampled including: care plans, policies and procedures and recruitment and training records. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 26 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use this service can expect to be provided with the necessary level of information to enable them to reach a decision about the services ability to meet their needs. They can also be assured that their needs will be assessed before they move into the home. Evidence: The home had a Statement of Purpose and Service Users Guide. The Statement of Purpose provided prospective service users or their representatives with information about the structure of the service, the qualifications of staff and the facilities provided. The document also included information on the homes complaints and admission processes. Both documents combined provided people with all of the necessary information to enable them to decide if the home would be able to meet their needs. Both documents were last reviewed in April 2009. Care Homes for Older People Page 11 of 26 Evidence: The care plan files of six service users were sampled and inspected. All six of these documents had good assessments of needs which the deputy manager said had been undertaken in the persons place of residence and are carried out by either the registered manager or one of the homes team managers. The assessments undertaken Included information on peoples social, psychological, health and spiritual needs. These assessments where applicable are supported by COM 5 assessments (these are assessments that are undertaken by representative of the local authorities). The home does provide intermediate care for people who require respite care and has five beds which are set aside for people requiring this service. At the time of the inspection visit there was one person living in the home who had been admitted requiring this service. Sampling of their care plan showed that an assessment of need had been undertaken and that a care plan was in place to enable their needs to be met. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use this service can expect their health and personal care needs to be identified in their care plans and therefore well met. They can also expect to be protected by the staffs practice relating to the administration of their medication. Evidence: The care plans of six people living in the home were sampled and inspected and they were used to case track care in the home. All of the care plans sampled contained an assessment of need. The care plans clearly identified for staff peoples needs and level of support required(for example, total support, partial support, or educative support) to enable these needs to be met. Staff spoken with during the course of the inspection visit spoke of being aware of the care plans and of being involved in their development. Within the sampled care plans, there was evidence of monthly reviews being conducted. All of the files sampled contained evidence of risk assessments with regard to manual handling, nutritional screening and falls. Where these risk assessments had identified Care Homes for Older People Page 13 of 26 Evidence: people as being at risk then care plans were seen to be in place relating to the identified risk. The home continues to operate a key worker system, and designated care team managers work alongside a number of key workers, to monitor their practice. Records relating to care plans were seen to be maintained on a daily basis to assist in ensuring a continuity of care. Within the records sampled and inspected their was good evidence of health care records being maintained. These records showed that people residing in the home were receiving health care input from a range of health care professionals including: G.Ps, practice district nurses, chiropodists, opticians, community psychiatric nurses, dietitians, physiotherapists and dentists. All relevant health care visits were arranged as necessary and the outcomes of these visits were recorded and reflected in the persons plan of care. The homes practice relating to the medication administration, record keeping, storage and stock control were sampled and inspected. The home operates a Measured Dosage System (MDS) and medication is stored securely in an air conditioned room to which only senior staff have access. Medication records and medicines sampled were all found to be in good order. The deputy manager reported that medication is only administered by care team managers and more senior staff and then only on completion of training provided by the dispensing chemist. This was confirmed to be the case by a care team manager who was spoken with during the course of the inspection. During the course of the inspection we observed and heard staff treating people who live in the home with dignity and respect. Interactions seen and heard were polite and respectful and staff displayed patience and understanding when supporting people. One person during a discussion with them said I would not want to be anywhere else, the staff are always so kind and polite another said you wont find better. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use this service can expect to receive care that will meet their individual needs and to be supported to make their own choices. Evidence: Throughout the course of the inspection staff were seen and heard interacting positively with people living in the home. They were observed chatting and talking with people as they went about their everyday tasks. The home employs an activities co-ordinator who works in the home on a full-time basis Monday to Friday 25 hours per week. Discussion with the co-ordinator indicated that a range of day time activities were provided. Records presented indicated that activities provided included: bingo, one to one sessions, excercises, reminescence sessions, floor games, quizis, craftwork, gardening, knitting, reading, massages, dominoes and films. In addition to the activities provided by the co-ordinator during the week the deputy manager spoke of taking people out at the weekend for meals to the local public house (photographic evidence was seen on the homes notice board of some of these outings, this was also confirmed during discussion with people living in the home). A visiting hairdresser visits the home every Thursday and Friday and Care Homes for Older People Page 15 of 26 Evidence: people spoken with said how much they looked forward to having their hair done. A church service takes place in the home on a monthly basis and coffee mornings are held every three monthly, to which relatives are invited. To facilitate peoples on-going interests in reading a mobile library visits the home fortnightly. Some of the people spoken with spoke of accessing this facility. Records sampled and inspected showed that an assessment is undertaken at the point of peoples admission into the home to ascertain information about their cultural background, personal interests and hobbies. The deputy manager spoke positively of promoting links with peoples families and friends. As mentioned above relatives are invited to the three monthly coffee morning. Blackthorns has an open door policy on the receiving of visitors, and people are free to receive their visitors either in their own rooms or the homes dedicated coffee lounge. Sampling of the homes visitors book showed that people were regularly visiting the home. During the inspection visit it was evident that people living in Blacktorns were able to move around the home as they wished. People spoken with indicated that they were able to choose to partake in the activities on offer, or if they chose to spend time in private in their own rooms this was fine. Evidence was seen of personal possessions in bedrooms e.g. pictures, ornaments and photographs and people spoken with confirmed that they had brought personal possessions with them when moving into the home. The home provides a four weekly rotational menus which showed that choices were available for all main meals. People spoken with said they were consulted with about what they would like to eat. Menus were seen to be on display around the home in each unit. Each unit also had its own small kitchenette area where drinks and light snacks could be prepared. Nutritional records were seen to be kept in respect of people whose nutrtional screening assessment had identified them as being at risk and theraputic diets were offered as required, although at the time of our inspection visit, there was no requirement for any. Comments received from service users in respect of the meals provided were positive, comments included Meals are very good. Food stocks seen on the day of the inspection visit were good and discussion with the catering staff on duty indicated that they generally felt that they had all of the necessary equipment to enable them to carry out their roles effectively. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be listened to and are cared for safely through the practice in the home. Evidence: The home has a complaints/compliments policy and procedure which is also referred to within their Statement of Purpose and Service Users Guide. Since the last key inspection ten complaints had been received by the home, three of which had been related to care, seven were other issues and two were related to peoples laundry. Records were kept of these complaints having been received and the records went on to show that all of the complaints had been investigated under the homes complaints policy/procedure and had been resolved to the satisfaction of the complainant. The home had in place an adult protection policy and procedure which was last reviewed in May 2009, which was comprehensive and was reflective of current practice, and referred to other relevant legislation and agencies. The home employs thirty-six care staff and its training matrix indicated that all had received training in this area. Discussion with staff during the course of our inspection visit indicated that they had a good level of knowledge and awareness on this subject. At the time of our visit no safe guarding referrals had been received by us in relation to the home. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the service enables people to live in a safe,wellmaintained and comfortable environment, which encourages them to maintain their independence. Evidence: Since our last key inspection of the home carried out in May 2007 the home has undergone a complete programme of refurbishment. All areas of the home visited were decorated to a high standard. All of the bedrooms visited were individually decorated, and people living in the home who were spoken with said how very pleased they were with the way in which their rooms had been redecorated. Each of the four units had its own lounge area and one their own dining room, the other three units shared a large dining area. As mentioned elsewhere in this report each unit has access to its own kitchenette areas where drinks and light snacks may be prepared by staff or people living in the home. The home was equipped with a range of aids and adaptations to enable people to maintain their independence, these aid and adaptations included: Hi-lo baths, hand grab rails, lo-slip floor surfaces, nurse call systems, hearing loop system. The corridors of the home were sufficiently wide enough to facilitate access and egress for those people who required the use of a wheelchair. Care Homes for Older People Page 18 of 26 Evidence: The homes laundry was well equipped with industrial style washing machines and tumble dryers and the home employs a laundry person to look after peoples washing. At the time of our inspection visit non of the people living in the home were looking after their own washing, this role was taken care of for them by their key workers. On the day of our visit all of the people seen were well presented, which would suggest that their laundry is generally well cared for. The home also has a sluice facility to enable them to deal with soiled items, however on the day of our visit this area was being used for storage. The deputy manager explained that at the time of our visit none of the people living in the home had a continence problem, therefore the sluice room was currently redundant. There is a need appropriate storage arrangements to be made. On the day of our inspection visit the home was extremely clean and tidy and there was no evidence of any unpleasant smells or odors. This would suggest that peoples needs are being met in an environment that is clean and tidy and generally well-maintained. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can expect to be supported by a staff team who are well trained and skilled and available in sufficient numbers to meet their needs and to support the smooth running of the service. Evidence: The homes duty rota was sampled for the week commencing the 5/7/2009 to the 11/7/2009. The rota indicated that the homes registered manager was working in the home Monday to Friday nine-five in a supernumerary capacity supported by an administrator working five hours a day Monday to Friday. Direct care staff support was being provided by nine care staff in the morning and eight in the afternoon, these figures were made up of one care team manager and six or seven care staff respectively. Night time support was provided by one care team manager and three care staff. The night support team is made up of dedicated night staff, the home does not do internal rotation of its staff team. In addition to the care staff the home employs a number of ancillary staff including cooks, domestics, laundry persons and maintenance staff. Discussion with staff indicated that they felt the staffing levels were sufficient to meet peoples needs and discussion with people living in the home suggested that this was the case also Care Homes for Older People Page 20 of 26 Evidence: The homes AQAA indicates that of thirty-four staff employed in the home seventeen hold a National Vocational Qualification (N.V.Q) at level two or above. This was further supported by records sampled including staff training records and the homes training matrix. The recruitment files of four members of staff were examined and found to contain all of the necessary evidence to indicate that a robust recruitment process was being undertaken by the home before staff commenced employment in the home. These checks included references, proof of identity and Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) clearance. The staff files sampled included evidence of any relevant qualifications. Staff spoken with as well as personal development files seen confirmed that they had undertaken relevant training to meet the diverse needs of people using the service, this training included:safe guarding, moving and handling, health and safety, food hygiene, fire awareness, infection control and first aid. Discussion with staff during the course of the inspection visit indicated that access to staff training was good. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed and safe home, where their views are sought and taken into account. Evidence: Since the last key inspection visit undertaken in May 2007, an appointment of registered manager has been made. This person has significant previous experience of working and managing in the care sector and holds the registered managers award. Discussion with staff indicated that they felt that the registered manager provided them with a clear sense of leadership and direction and was always readily accessible if they had any concerns or issues. The management structure within the home had clear lines of accountability and both staff and people living in the home had a good sense of the structure and direction of leadership in the home. Care Homes for Older People Page 22 of 26 Evidence: Runwood Homes plc have an annual development plan and customer and catering satisfaction surveys are sent out annually. Comments received back from the last one carried out included: standard of care seems good atmosphere in the home is good friendly and welcoming lovely and clean environment revamp is fantastic To enable people living in the home and staff the opportunity to air their views or raise any concerns the registered manager holds monthly surgeries. In addition to these surgeries general staff meetings and care team manager meetings are held monthly. Copies of reports following visits by the registered provider (Regulation 26 visits/reports) were sampled and inspected. Reference was made to the last report carried out by us in May 2007 and the homes annual development plan. Of the six people living in the home who were case tracked as part of out inspection process, monies held by the home relating to two were sampled. The monies and records sampled for these two people were found to be in order, with evidence in place to provide for an audit trail of expenditure. The homes safe working practices were in order, records and policies were in place to protect people living in the home and the staff supporting them. The necessary certificates relating to equipment and services to the home were in place and were being updated as required. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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