Care Home: Thorn Hall Residential Care Home

Similar services:

• Abbey The
• Snydale Care Home
• Hawkhills
• Larchfield Manor
• Beeches The - North Yorkshire County Council
• Carentan House
• Ravensworth Lodge

What the care home does well People are appropriately assessed on entry to the home, having been given satisfactory information on what the home is like and what to expect. They are provided with a contract of residence and there are care plans for staff to follow. They are supported with health care that meets their needs and their expectations.People are protected from possible harm, due to taking the wrong medication, because they have their medication handled by the staff in the home, and the staff follow robust practices and procedures. The service handles medication well and staff are trained in medication administration. People experience good levels of privacy, have their dignity maintained, and their right to make decisions is respected. They are encouraged to maintain contact with family members and friends and enjoy visits from them any time of the day, and they are encouraged to exercise choice and control over their lives. People enjoy satisfactory food, which matches their expectations and preferences, but also offers a satisfactory level of nutrition. They are confident their complaints will be listened to and acted upon, and any representations or allegations are taken seriously and dealt with appropriately. People are protected from abuse by robust recruitment and selection procedures and practices. A sufficient number of care staff work in the home on each shift to meet the assessed and changing needs of people. The manager runs the service in the best interests of the people that live there and maintains their health, safety and welfare. The home is protected in respect of health and safety and fire precautions etc. What has improved since the last inspection? A new statement of purpose and a new service user guide have been devised and provided to people in the home following the new ownership. New assessment documentation has been introduced and new care plans have been implemented with a format that includes a wider range of diverse care needs. There are new menus in place that offer a wider choice of teatime foods. A new service contract has been set up for the maintenance of the lifting hoist and stair lift, and for the collection of waste. The heating systems have also been repaired and maintained since the last inspection. The external ramp has been made safe with a new surface and the requirements of a fire officer visit have been attended to. There is a new registered manager in post. What the care home could do better: The service could provide prospective people with written confirmation their assessed needs can/cannot be met by the home, so people know their needs will be met. The service could make sure any medicines requiring colder storage are stored appropriately in a dedicated fridge (if necessary) and that the medication trolley be stored in an alternative place to the main entrance hall, so people are confident their medicines are stored appropriately, safely and securely. The service could make sure staff administering medications receive annual competence training in the safe administration of drugs, according to the requirements of the Medicines Act 1968, the Misuse of Drugs Act 1971 and guidelines from the Royal Pharmaceutical Society, so people are confident their medication is being safely administered. It could make sure the homes assessment tool covers all areas listed in standard 3.3, so people know their diverse needs are being thoroughly assessed and met. It could make sure care plans and all other documents have appropriate signatures on them and that care plans have an action plan for each assessed area listed in standard 3.3, so people are confident they are being included in the process and they know their needs will be met. It could make sure care plans are used by staff as a daily tool for informing them of people`s changing needs, and diary notes to show how needs are met should be written less judgementally, so people are confident their needs are known, are reviewed and are met without bias. It could make sure people with less cognitive ability have improved opportunities for going out and engaging with the local community, so people know their social and recreational needs will be met. It could make sure people are consulted about menu compilation and about choice alternatives, so people are confident their food choices and wishes are respected. It could make sure the complaint record contains greater detail on people`s complaint and how/whether or not they were satisfied. There should also be a log of complaints to enable easy identification of trends. These are so people are confident their complaints will be recorded properly and any trends will be dealt with effectively. It could annually offer all staff external safeguarding adults training/refresher course so they are competent in dealing with safeguarding issues and so people are confident they will be protected from abuse, neglect or harm.It could make sure all areas of the home are reasonably decorated and that furniture is adequate for their needs, so people are confident they live in a comfortable and pleasant environment. The lounge/conservatory and some bedrooms need redecorating and new furniture purchasing. It could make sure staff continue with skills training and development to enable them to care for people with conditions relating to old age, so people are confident their needs will be met. It could make sure there are accounting sheets (not just computer records) for people with money held in safe keeping, showing date, transaction type and reason, amount, balance and two staff signatures, so people are confident they are being protected from financial abuse. The service could continue to meet the requirements of the fire prevention officer`s visit in June 2008, and replace the upper floor fire doors with ones of increased fire resistance and that have intumescent cold seals in, so people are protected from the risk of harm from fire. The service could ask staff to sign the fire drill record as proof of attendance at fire safety training drills, and make sure staff have at least two fire training drills in every twelve-month period, so people are protected from the risk of harm from fire. CARE HOMES FOR OLDER PEOPLE Thorn Hall Residential Care Home West Wing Thorngumbald Hull East Yorkshire HU12 9LY Lead Inspector Janet Lamb Key Unannounced Inspection 08:30 27 June & 2nd July 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thorn Hall Residential Care Home Address West Wing Thorngumbald Hull East Yorkshire HU12 9LY 01964 622977 01964 622386 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) www.pwccare.co.uk PWC Care Limited Mrs Nicola Jane Dunn Care Home 19 Category(ies) of Dementia (19), Old age, not falling within any registration, with number other category (19) of places Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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, and Dementia - Code DE The maximum number of service users who can be accommodated is: 19 27/02/07 2. Date of last inspection Brief Description of the Service: Thorn Hall is a residential home that is registered to provide accommodation and personal care to 19 older people some of who may have dementia care needs. Short-term, day care or respite care is also provided. Fees for the home range from £350.00 to £396.50 per week, though the provider only ever charges the minimum local authority rate. This information was obtained from the provider on the 27th June 2008. Information about the home and the service provided may be found in the statement of purpose and service user guide on the notice board of the home or by requesting that these be sent to you through the post. The home is situated in the village of Thorngumbald and is set in extensive well kept grounds, with ramped access. There are two distinct areas to the home. One is in part of the original building, which was built in the mid nineteenth century, and where there are two bedrooms on the ground floor and five bedrooms on the upper floor, two of which are shared. There is also an office on this floor, which is accessible by a stair lift. The other area is in the extension, which provides ten single bedrooms that are on the ground floor. None of the bedrooms have en suite facilities. There are adequate numbers of baths and toilets, with adapted equipment available. A conservatory links the two parts of the home, which was used as a smoking area, but smokers are now required to use the outside of the building. People usually smoke in the small open space just outside the conservatory that leads to the rear garden. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 5 There are two lounges, a dining room and a kitchen on the ground floor. Parking facilities are available for several vehicles to the rear of the property. The home does not provide nursing care, should such care be required on a short-term basis then it is provided by the community healthcare services. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2-star. This means the people who use this service experience good quality outcomes. The Key Inspection of Thorn Hall has taken place over a period of time and involved sending an ‘annual quality assurance assessment’ (AQAA) document to the home in April requesting information about people and their family members, and the health care professionals that attend them, as well as asking for numerical data held in the home. We received the requested information in May 2008 and survey questionnaires were then taken to the home on the day of the site visit where people and any visiting relatives were asked to complete them. The information already known from having had contact with the home over the last few months, following the registration of the new owner, and from other sources was used to suggest what it must be like living there. Janet Lamb made a site visit to the home on 27th June 2008, and a second one on 2nd July 2008 to test the suggestions made about the home, and to interview people, staff, visitors and the home manager, and to give people the chance to complete a survey to offer other information. Some documents were viewed with permission from those people they concerned, and some records were also looked at. The premises were viewed and private areas, also with people’s permission, were looked at. A total of five people, two staff, the provider and manager were spoken to or interviewed during the site visit and several more people living in the home were observed. All of the information collected, in conversations, through observation and in survey questionnaires was collated to determine what it must be like living there. Although the home is under a new registration, not all of the standards were assessed. All key standards and some extras were however. What the service does well: People are appropriately assessed on entry to the home, having been given satisfactory information on what the home is like and what to expect. They are provided with a contract of residence and there are care plans for staff to follow. They are supported with health care that meets their needs and their expectations. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 7 People are protected from possible harm, due to taking the wrong medication, because they have their medication handled by the staff in the home, and the staff follow robust practices and procedures. The service handles medication well and staff are trained in medication administration. People experience good levels of privacy, have their dignity maintained, and their right to make decisions is respected. They are encouraged to maintain contact with family members and friends and enjoy visits from them any time of the day, and they are encouraged to exercise choice and control over their lives. People enjoy satisfactory food, which matches their expectations and preferences, but also offers a satisfactory level of nutrition. They are confident their complaints will be listened to and acted upon, and any representations or allegations are taken seriously and dealt with appropriately. People are protected from abuse by robust recruitment and selection procedures and practices. A sufficient number of care staff work in the home on each shift to meet the assessed and changing needs of people. The manager runs the service in the best interests of the people that live there and maintains their health, safety and welfare. The home is protected in respect of health and safety and fire precautions etc. What has improved since the last inspection? A new statement of purpose and a new service user guide have been devised and provided to people in the home following the new ownership. New assessment documentation has been introduced and new care plans have been implemented with a format that includes a wider range of diverse care needs. There are new menus in place that offer a wider choice of teatime foods. A new service contract has been set up for the maintenance of the lifting hoist and stair lift, and for the collection of waste. The heating systems have also been repaired and maintained since the last inspection. The external ramp has been made safe with a new surface and the requirements of a fire officer visit have been attended to. There is a new registered manager in post. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 8 What they could do better: The service could provide prospective people with written confirmation their assessed needs can/cannot be met by the home, so people know their needs will be met. The service could make sure any medicines requiring colder storage are stored appropriately in a dedicated fridge (if necessary) and that the medication trolley be stored in an alternative place to the main entrance hall, so people are confident their medicines are stored appropriately, safely and securely. The service could make sure staff administering medications receive annual competence training in the safe administration of drugs, according to the requirements of the Medicines Act 1968, the Misuse of Drugs Act 1971 and guidelines from the Royal Pharmaceutical Society, so people are confident their medication is being safely administered. It could make sure the homes assessment tool covers all areas listed in standard 3.3, so people know their diverse needs are being thoroughly assessed and met. It could make sure care plans and all other documents have appropriate signatures on them and that care plans have an action plan for each assessed area listed in standard 3.3, so people are confident they are being included in the process and they know their needs will be met. It could make sure care plans are used by staff as a daily tool for informing them of people’s changing needs, and diary notes to show how needs are met should be written less judgementally, so people are confident their needs are known, are reviewed and are met without bias. It could make sure people with less cognitive ability have improved opportunities for going out and engaging with the local community, so people know their social and recreational needs will be met. It could make sure people are consulted about menu compilation and about choice alternatives, so people are confident their food choices and wishes are respected. It could make sure the complaint record contains greater detail on people’s complaint and how/whether or not they were satisfied. There should also be a log of complaints to enable easy identification of trends. These are so people are confident their complaints will be recorded properly and any trends will be dealt with effectively. It could annually offer all staff external safeguarding adults training/refresher course so they are competent in dealing with safeguarding issues and so people are confident they will be protected from abuse, neglect or harm. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 9 It could make sure all areas of the home are reasonably decorated and that furniture is adequate for their needs, so people are confident they live in a comfortable and pleasant environment. The lounge/conservatory and some bedrooms need redecorating and new furniture purchasing. It could make sure staff continue with skills training and development to enable them to care for people with conditions relating to old age, so people are confident their needs will be met. It could make sure there are accounting sheets (not just computer records) for people with money held in safe keeping, showing date, transaction type and reason, amount, balance and two staff signatures, so people are confident they are being protected from financial abuse. The service could continue to meet the requirements of the fire prevention officer’s visit in June 2008, and replace the upper floor fire doors with ones of increased fire resistance and that have intumescent cold seals in, so people are protected from the risk of harm from fire. The service could ask staff to sign the fire drill record as proof of attendance at fire safety training drills, and make sure staff have at least two fire training drills in every twelve-month period, so people are protected from the risk of harm from fire. 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. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People’s individual and diverse needs are well assessed so they are confident needs will be met. They receive sufficient written information in the form of a statement of purpose and a service user’s guide, and they are offered trial stays so they can decide if the home is the right place for them. They have satisfactory contracts of residence. EVIDENCE: The home’s new statement of purpose and service user guide have been developed and seen as part of the new registration under PWC Care Ltd. They were considered satisfactory for registration and remain so for this inspection. People are offered visits to the home to look round, trial stays to sample the care and environment and a statutory period of ‘probation’ – six weeks to determine whether or not they wish to stay permanently. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 12 There are new contracts of residence in place for people because of the new ownership and a sample blank contract was seen. People were asked about their contracts, but they could not remember exactly what they contained or that they had indeed seen contracts. People were sure they had seen some information held on them and all but one were generally not interested. The person who did ask about files held asked to view his. This he did while we talked to him about living in the home. There are new assessment documents in place for assessing the needs of any prospective people to the home. These contain eleven areas of need – mobility, health, senses, general health, communication, eating, drinking, leisure, occupation, religion and emotional state. There are also RA documents in place also, which cover environment, falling, nutrition, pressure care and use of bed rails. Together all of these appear to cover the requirements of standard 3.3. The manager is recommended to check this is so. The manager is required to provide each newly assessed prospective person to the home with written confirmation his/her needs can/cannot be met, as required under regulation 14(d). Standard 6 is not applicable. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. 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 feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service receive good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People have their health and social care needs satisfactorily documented in care plans, so they are confident all their needs will be met. They have no opportunities to self-medicate, but their medication needs are adequately managed. They enjoy good levels of privacy and their dignity is well maintained, so they are confident their overall quality of life is satisfactory. EVIDENCE: New care plans are in place for almost everyone and they contain four areas – strengths, needs, risks and goals. Issues covered include those listed above in the assessment document. There are also care plan checklist, record of visits from GPs etc., lists of peoples’ preferences, monthly evaluation sheets and care plan agreements though these are not signed. Plans are drawn up from the placing authority’s Community Care Assessment document, held in the home, and the home’s assessment documents. Health care issues are also included. There are diary notes and key worker notes in Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 14 use and monthly reviews held. Six monthly reviews of the whole care plan are held in line with authority requirements and relatives and officers of the authority are invited to annual reviews. Copy documents are held for ‘Fair Access to Care Services’ (FACS) reviews and for the home’s own reviews. Again, people spoken to about their care plans were not really interested. One person said, “I didn’t know I had a care plan. I don’t remember any assessment being done, but then I was ill before I came here.” One chose to look at his file and another said she might like to look at hers. Personal and health care needs are well met on a daily basis and according to people’s daily routines, but care staff ought to use care plans more as a tool for determining what people’s needs are and when and how they change. Policies and procedures are in place for medication administration systems. Medication is stored in a dedicated trolley pinned to the wall in the main entrance hall. An alternative place for this ought to be found, and a medication fridge for those medicines requiring cooler storage should be obtained. Alliance Chemist supply drugs in the Manrex system, to which there are accompanying administration record (MAR) sheets. MAR sheets held in a medication record file now have pictures of people so they are easily identifiable. MAR sheets are satisfactorily filled out, showing omission codes, dates, signatures etc. Sample signatures of staff giving out drugs are also kept to the front of the record file. Observation of a senior staff giving out medication showed they follow procedure and safe handling codes. A control drug (CD) cabinet is available in the office upstairs and is fixed to the wall, but there are no CDs used in the home at the moment. Returns are recorded and signed for on receipt by the chemist. Staff have medication administration training if they are seniors and are to give out medication. Their competence to do so ought to be checked annually with an external source where possible. People spoken to about their medication are satisfied with the arrangements for storage and handling. One said, “I wouldn’t want to look after my medication, because I loose track of time and might get it wrong.” Another said, “I only take aspirin on occasion anyway.” Privacy and dignity are satisfactorily upheld. Some people leave their ground floor room doors open for company, most speak of care being done in private and of maintaining good levels of privacy. Observations were made of staff being discreet and only providing personal assistance in private. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 15 One person said, “I do get all the help I need with my personal care, though most of the time I try to do things for myself. The girls are very nice.” Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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 maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People enjoy good flexible routines, good contact with relatives and friends and have good opportunities to be selfdetermining. They have some opportunities to engage in pastimes but have fewer opportunities for going out. The provision of food is satisfactory, but the chance to contribute to menu planning is not. This means people are confident their daily lives and some of their social activities meet their expectations. EVIDENCE: People have flexible routines and lead independent lives where possible as is observed and as they describe. A couple of people go out daily to the local shops or just for a walk. One or two attend local churches as they chose to. Information about the local area and activities in the village etc. is provided on the notice board or verbally. People are able to choose what they do on an individual basis, though those with less cognitive ability are encouraged and supported by staff. We saw people playing dominoes, watching TV, reading newspapers, listening to music, talking to staff and each other, receiving visitors and going out for short walks. One person explains she has a kettle in her room, as she is capable of using it safely. Diary notes and activity records Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 17 back up what people do etc. Perhaps more opportunities to go out could be offered to those with less ability. Visitors to the home are usually between meals, but no one is refused entry. Several visitors were seen on the day of the site visits and one completed a survey before they left. They visited their relative in her room and in private. People are encouraged to handle their own finances if capable, but mostly relatives do so. There are three people with money held in safe keeping by the home and this is secure, has records to show transactions, dates, amount etc. and is satisfactorily accounted for. Two people interviewed do not have money held for them, but two that do had their records and balances checked. They are satisfactory. One person has an umbrella bank account within the home’s business account because she has no ability to control her finances. Her son has agreed to this and everything is appropriately managed, recorded and audited. The son handles finances on her behalf. Others spoken to say they have relatives or friends in control of their finances and these arrangements are good. Food provision is generally satisfactory. People spoken to say, “I have no complaints about the food,” and “the meals are good.” One person did express the view that the food is not as good as it used to be and that she didn’t get the milk drinks in the evening like she used to. Also one staff spoken to felt the teatime option could be better and more varied, instead of always sandwiches. One person was specifically asked if there was enough choice at teatime and she confirmed there was usually a selection of sandwiches, but that some people chose eggs on toast etc. if they did not like the sandwiches on offer. It did not appear to be a problem with people, but perhaps they are so used to this they do not expect anything else. The hot meals seen on the site visit days looked nourishing and plentiful; it was minced beef, French beans, carrots, mashed potato and gravy on the first day and fish, chips, mushy peas or pie instead of fish on the second day. Puddings seen were rice pudding, fresh fruit or ice cream. Perhaps an exercise as part of the quality assurance checks could be carried out to seek peoples’ views about menu compilation, choice alternatives and speciality foods as special treats. The provider was asked about food provision and she explained that a complaint had come in since taking over the ownership of the home, about only having sandwiches at teatime, so new menus had been devised, were laminated and put on display. This was being monitored. People ought to be consulted more regularly about their food likes and choices. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 18 The kitchen was not inspected, only seen briefly from the door, but appeared adequately equipped and clean. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 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’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People make use of the formal complaint system or are aware they can do at any time, so they are confident their concerns are listened to and usually dealt with effectively and efficiently. They also experience good promotion and protection of their welfare and so feel confident the systems in place to protect them are robust. EVIDENCE: There are new procedures in place for dealing with complaints and handling safeguarding issues. The statement of purpose clearly shows information regarding these and people in the home and their relatives have been informed of them and of how to make representations. The provider explains there has been one formal complaint about food provision at teatime and this was addressed satisfactorily, though one staff felt it needs voicing again. Other issues have been informally voiced and addressed. People interviewed say they are able to speak up as issues arise, one had already had some problems of a relationship nature with another person and their concerns were being considered and solutions found. Another person had been able to speak up about the attitude of a staff member and had been listened to and action had been taken. These were issues the management were able to discuss openly and explained how they had been dealt with Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 20 satisfactorily. Everyone felt these had now been addressed. Records need to be much more detailed however, regarding people’s problems and how they are resolved. It is also advised that a complaint log be set up to show at a quick glance what problems are arising and what trends there may be. Staff have not received training in safeguarding adults issues and awareness, but discussion with them reveals they do know how to make representations should they suspect anything or be told anything. The manager and the administrator have both done the manager’s safeguarding adults training with Hull & East Riding Safeguarding Adult’s Board, and the manager then cascaded the information down to staff. It would be beneficial, however, if the staff were to attend their own external safeguarding training over the next twelve months and update this annually. This is recommended on the report. Staff training files show what they have/have not done and they confirm the information in interview. The provider has dealt with one inherited safeguarding issue, which was originally looked at as a complaint by the previous owner. The provider has dealt with this satisfactorily, considering the timescales and the need to make sure people are protected. The provider has also dealt with another staffing issue appropriately, which did not impact on the service of care other than in respect of a staff shortage on a couple of shifts. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience adequate quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People have a satisfactorily maintained, safe, adequately clean and comfortable environment in which to live, so they are confident they have an adequate home. EVIDENCE: Generally the home is suitable for its stated purpose of providing care and accommodation to older people. Information provided shows there has been an assessment of the home’s aids and adaptations in the past, but this was in 2003. Observation shows the home has had some minor refurbishment completed since the change of ownership; some bedrooms redecorated and some linen purchased. There has been a renewal of the external wheelchair ramp to make it safer for use, and new fire doors have been fitted to the laundry and boiler room and windows have been repaired against reported draughts. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 22 There are new contracts in place for the lifting hoist, the chairlift and pest control, as these appeared not to be included in the maintenance programme on change of provider. There is also a new maintenance programme in place and the new provider is concentrating on making sure the fire safety requirements are met first. See section on ‘Management’ below. There are still some areas for redecoration and the rear lounge and open conservatory area is definitely due some revamping and upgrading. The provider is aware of this and future plans include consulting people about the lounge areas before any work is done. The front lounge is very pleasant but used rarely, except by one or two people. The provider intends to alter one of the upper floor bathrooms into a staff room, by removing the shower and bath unit, but discussions highlighted the need to keep either the bath or the shower in this room, as there are only two more bathrooms available to the 19 people that could be accommodated. There must be one bathroom to every 8 people accommodated – the home needs to retain 3 for people to use. The bathroom in question may have one of the facilities removed, bath or shower, and can be used primarily by staff, but it must remain a useable bathroom facility. An area where improvements can be made is the refurbishing of bedrooms, as much of the furniture is old and dated and bedrooms also require redecoration. Some have been redecorated, but the standard of painting is not high. Finally the conservatory presents as ‘dishevelled,’ since the corrugated ceiling is discoloured and covered in moss or debris and the floor is uneven. The overall effect is not that of a lounge/sitting area, but of a utility area or thoroughfare. It is a very popular area with people living in the home and the staff though and is very well used. This is probably because everyone uses the side door from it as the main entrance to the home. It is a shame the main entrance to the front of the west wing is not used. The home is clean and free from malodour. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People are cared for by appropriately recruited, trained, confident and partly skilled staff in satisfactory numbers to meet their needs, so they enjoy a good service of care. EVIDENCE: Discussion with the provider, manager and staff and viewing of staff files, rosters etc. reveals there are satisfactory levels of staff on duty with sufficient qualifications and that the recruitment practices have improved since the last key inspection. Staff training appears adequate. The Residential Staffing Forum figures for 4 high, 8 medium and 3 low dependency people living in the home reccommends there should be between 309 and 393 care hours per week. The homes roster for the week commencing 16/06/08 shows 415 care hours were provided throughout the day and night. This means there are sufficient care hours being provided each week to meet the needs of the people in the home. Staff in interview say there are now opportunities to talk to people more, socialise with them and do such as nails etc. Of the 19 care staff working in the home there are now 10 with NVQ Level 2 and/or Level 3, and there are 8 more undertaking the award. Therefore the Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 24 home has 53 of care staff with and 95 will soon have the required qualifications to do the job. Recruitment and selection practices have improved since the last inspection and of the staff files belonging to present employees viewed with their permission, all had an application form, references, a Criminal Records Bureau check (some with POVA first checks), personal identification details, and declaration that policies and procedures had been read. Staff trianing records and certificates show staff have completed training in fire safety, medication administration (seniors only), moving and handling, food hygiene, continence care and first aid. It is recommended that staff continue to up-date their training and do new courses where possible to improve on their skills to care for people with specific needs of older age. There are nine staff booked to undertake dementia awareness training in July 08. Although some staff have done abuse and the protection of adults training over the past couple of years they have only done ‘cascaded-down’ in-house training or read the Hull and East Riding procedure manual. A handbook was provided to them after the in-house training. Therefore it is recommended they complete an external training day where possible, so that everyone is upto-date with the most current adult protection training available. The manager and the administrator have completed external safeguarding adults training in November 2007 (this was info cascaded to staff). This recommendation is made in standard 18 on ‘protection’. Discussion with staff shows they are aware of their responsibilities to protect people and to be skilled in caring for those with particular needs of older age. They are willing to learn and train. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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 the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience good quality outcomes in this area. This judgement has been made using evidence gathered both during and before the visit to the service. People live in a home that is satisfactorily run and in their best interests, where appropriate systems are in place to determine the quality of the service. Peoples financial interests are generally not the responsibility of the home, though three receive some satisfactory support. People’s health, safety and welfare are well promoted and protected, so they are confident they are safe and well cared for. EVIDENCE: The manager was registered in December 2007 as new manager to the new provider. The manager has worked in the home some years as senior though before this. She has tried to begin the NVQ 4 Registered Manager’s Award, but has yet been unsuccessful. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 26 There is a quality assurance system in place at the moment, which includes surveying people in the home every two months on such as the food, their rooms, changes in care, etc. The system also uses key worker time spent with people and the recording of this, as well as house meetings, staff meetings, and monitoring of the complaint systems. Relatives are also contacted about social events, are surveyed on the cleanliness of the home, if the room is good their relative lives in and on whether they feel welcome or not etc. There is usually a 50 return on surveys from relatives. The home has also tried surveying the local GPs that visit, but the response has been very poor. A visiting GP is reported to have made comments that things seem to be improving after the change of provider. Information collected over the first months of the new provider’s management has been collated to produce a basic report on how things are progressing. The provider is to use this and also the completing of the AQAA for this inspection, to establish what areas need improvement and what people find lacking in their care. The system needs developing further and then reviewing. If a review of systems takes place the Commission requires a copy of the report, under regulation 24(2). The home has suitable systems for handling peoples’ finances, in that there is a dedicated administrator, only three people have money in safe keeping, and there are records held etc. There is a need for accounting sheets though, to show how, when and how much is transacted for individuals’ money held for them. The manager, administrator or senior on duty is responsible for holding the only key to the cupboard where finances are held and there is a hand-over procedure for the key. One person has an umbrella account within the company’s own business account, which was approved by her relatives. The person receives statements and has her own chequebook for her account, as she is unable to handle finances herself. Her son deals with money if necessary. He receives monthly invoices for any expenditure that occurs. Areas that were looked at under standard 38 include fire safety, lifting equipment, legionella water test and use of hazardous substances. Fire safety has been addressed since the new provider took over and a visiting Fire Prevention Officer identified a lot of work to be done. The visit was completed in early June 2008 and the main requirements were to fit new fire doors, include intumescent strips, change many detectors from heat to smoke ones, attend to closers, fit door guards only where necessary and make sure batteries are changed regularly, replace the laundry door with an improved one for longer safety protection and make the fire exit ramp safer. All of this is being attended to as finances are available, and almost all of it has been completed with the exception of some new fire doors on the upper floor. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 27 Records seen for fire safety checks include the service of systems in Feb 08 by Image 2000, and extinguishers checked on 12/06/08. The home carries out fire drills as appropriate – the last ones recorded as March 08 and June 08, when 6 drills were carried out. The record only states that all staff were present but does not show staff by names. There must be a minimum of two fire safety drills held for each staff member in every 12-month period. These are recommendations of this report. There is a stair lift and a mobile hoist in the home and both have been serviced in February 2008, under a new service contract with a company called LMB Ltd. The home has had the hot water storage system checked for legionella bacteria in April 2008, when 5 samples were taken. Results were satisfactory. The home has a limited number of substances it uses for cleaning and these have appropriate information in the form of Control Of Substances Hazardous to Health leaflets and dilution instructions. These are being followed. Further information supplied by the management includes the following: - a new waste collection service and contract has been set up, the heating systems have been repaired and are now working well, and staff are being given responsibility to assist people to choose the redecoration of their rooms. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 28 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14(d) Requirement The registered provider must provide prospective people with written confirmation their assessed needs can/cannot be met by the home, so people know their needs will be met. The registered provider must make sure any medicines requiring colder storage are stored appropriately in a dedicated fridge (if necessary) and that the medication trolley be stored in an alternative place to the main entrance hall, so people are confident their medicines are stored appropriately, safely and securely. The registered provider must make sure staff administering medications receive annual competence training in the safe administration of drugs, according to the requirements of the Medicines Act 1968, the Misuse of Drugs Act 1971 and guidelines from the Royal Pharmaceutical Society, so DS0000071309.V366862.R01.S.doc Timescale for action 31/10/08 2 OP9 13(2) 30/11/08 3 OP9 13(2) and (6) 31/12/08 Thorn Hall Residential Care Home Version 5.2 Page 30 people are confident their medication is being safely administered. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations The registered provider should make sure the homes assessment tool covers all areas listed in standard 3.3, so people know their diverse needs are being thoroughly assessed and met. The registered provider should make sure care plans and all other documents have appropriate signatures on them and that care plans have an action plan for each assessed area listed in standard 3.3, so people are confident they are being included in the process and they know their needs will be met. The registered provider should make sure care plans are used by staff as a daily tool for informing them of people’s changing needs, and diary notes to show how needs are met should be written less judgementally, so people are confident their needs are known, are reviewed and are met without bias. The registered provider should make sure people with less cognitive ability have improved opportunities for going out and engaging with the local community, so people know their social and recreational needs will be met. The registered provider should make sure people are consulted about menu compilation and about choice alternatives, so people are confident their food choices and wishes are respected. The registered provider should make sure the complaint record contains greater detail on people’s complaint and how/whether or not they were satisfied. There should also be a log of complaints to enable easy identification of trends. These are so people are confident their complaints will be recorded properly and any trends will be dealt with effectively. 2 OP7 3 OP7 4 OP12 5 OP15 6 OP16 Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 31 7 OP18 8 OP19 9 OP30 10 OP35 11 OP38 12 OP38 The registered provider should annually offer all staff external safeguarding adults training/refresher course so they are competent in dealing with safeguarding issues and so people are confident they will be protected from abuse, neglect or harm. The registered provider should make sure all areas of the home are reasonably decorated and that furniture is adequate for their needs, so people are confident they live in a comfortable and pleasant environment. The lounge/conservatory and some bedrooms need redecorating and new furniture purchasing. The registered provider should make sure staff continue with skills training and development to enable them to care for people with conditions relating to old age, so people are confident their needs will be met. The registered provider should make sure there are accounting sheets (not just computer records) for people with money held in safe keeping, showing date, transaction type and reason, amount, balance and two staff signatures, so people are confident they are being protected from financial abuse. The registered provider should continue to meet the requirements of the fire prevention officer’s visit in June 2008, and replace the upper floor fire doors with ones of increased fire resistance and that have intumescent cold seals in, so people are protected from the risk of harm from fire. The registered provider should ask staff to sign the fire drill record as proof of attendance at fire safety training drills, and make sure staff have at least two fire training drills in every twelve-month period, so people are protected from the risk of harm from fire. Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Thorn Hall Residential Care Home DS0000071309.V366862.R01.S.doc Version 5.2 Page 33 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!