Care Home: Thorncliffe

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What the care home does well The home offers people a well maintained, secure and homely environment to live. Staffing levels were assessed and found to be appropriate to meeting the needs of people living there at that time. There were further indications that a stable and committed staff team is employed at the home.Records maintained by the home and staff set out the level of support required and daily records were maintained of the support provided to people by staff. Comments by relatives and people living there indicated a good balance was maintained in meeting people`s personal and social care needs. This was evident in daily recordings and positive interactions between staff and people living there. What has improved since the last inspection? The manager had completed the National Vocational Qualification at level 4, and programmes of training for staff had addressed provision of NVQ training for all care staff. The requirements made at the previous inspection, in relation to developing records to evidence the homes initial assessments and care planning arrangements have been fully met. The home had taken appropriate action to ensure all incidents and accidents are recorded within the homes recording procedures. CARE HOMES FOR OLDER PEOPLE Thorncliffe Crescent Road Dukinfield Tameside SK16 4EY Lead Inspector Joe Kenny Unannounced Inspection 10 July 2008 10:00 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 Thorncliffe DS0000005590.V364669.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. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thorncliffe Address Crescent Road Dukinfield Tameside SK16 4EY 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) 0161 339 7055 NO FAX Mrs Marilyn Ann Norton Mrs Marilyn Ann Norton Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (15), of places Physical disability over 65 years of age (8) Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 15 OP, up to 15 DE (E), up to 8 PD (E). Date of last inspection 16th November 2007 Brief Description of the Service: Thorncliffe is a large, detached building that has been extended and adapted to meet the needs of 15 older people, some of whom will have physical disability or dementia. The accommodation is provided on two floors. There are 11 single and two shared bedrooms, none of which have en-suite facilities. On the ground floor there are two lounges, a conservatory and one dining room. Adapted toilets and bathrooms are available close to the communal rooms and private accommodation. Details of the facilities provided by the home are contained in the service user guide, which is displayed in the entrance hall. There is an enclosed garden to the rear of the property, accessible from the conservatory. Car parking is to the front of the building. The home is located on a bus route close to the centre of Ashton. Off road parking is provided at the front of the house. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 5 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 inspection of Thorncliffe was carried out unannounced on the 10 July 2008. The registered person, who is also the manager, was available throughout the inspection. The information relating to people recently admitted to the home was examined to see how people are supported as they move to the home. Staff files and other documentation such as complaints, medication, staff rotas, training records and health and safety records were also looked at as part of the inspection. Discussions were held with staff, people living there and with relatives visiting to seek their views about Thorncliffe. The home provided the Commission with a completed self-assessment of how it felt it was meeting national minimum standards, with additional information about the service they provide and staffing information. The inspection also looked at information received by the Commission in relation to the home prior to the site visit. A number of comment cards were forwarded to people living there and to staff as a further means of seeking their views. Comment cards form four relatives, three staff and three service users were received and extracts are used in parts of this inspection report. A tour of the home and grounds was also undertaken. The fees for the home are £377.03 per week for single rooms and £287.16 per week for shared rooms. The home does not provide intermediate care. What the service does well: The home offers people a well maintained, secure and homely environment to live. Staffing levels were assessed and found to be appropriate to meeting the needs of people living there at that time. There were further indications that a stable and committed staff team is employed at the home. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 6 Records maintained by the home and staff set out the level of support required and daily records were maintained of the support provided to people by staff. Comments by relatives and people living there indicated a good balance was maintained in meeting people’s personal and social care needs. This was evident in daily recordings and positive interactions between staff and people living there. What has improved since the last inspection? What they could do better: 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. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 7 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 Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 8 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): 3. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that people’s needs for care are identified and are able to be met by the home. EVIDENCE: There were no vacancies at the home at the time of the visit, and the home continues to operate at full occupancy. In the event of a vacancy the manager described the process to support a person moving to the home. This included receiving a completed assessment of the person’s needs from the care manager/local authority funding the placement. In addition the manager will meet with the person in their home or hospital to complete and gather Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 9 additional information to assist in developing a programme of care to support the person moving to Thorncliffe. People are also encouraged to visit the home before they move and a number of people living there confirmed that this had happened. Once a person moves to the home they are provided with a contract or statement of the terms and conditions of their placement. The files of three people who recently moved to the home were examined. The files contained information from the placing authority and further evidence of the information the manager had gathered prior to their admission. People funded by the Local Authority are provided with a statement of terms and condition of their placement and private funded people are provided with a contract. Records contained information relating to family and professional contact details, the level of support people required and copies of their placement agreement. As part of the inspection, time was spent in discussions with groups of relatives visiting the home and all said they were happy with the care and support offered to their relative. One relative using the comment cards confirmed a visit was carried out to view the home. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 10 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and personal care needs are clearly recorded in care plans and are drawn up in consultation with people or their representative as to how they wish to be supported. EVIDENCE: Information in the care plans for people most recently admitted was informative and set out the level of care and support each person needed. Records of how staff should assist and support the person’s identified care need supported this information. Records also contained information about specific health care needs and contact details for the health professionals supporting them. Additional information related to people’s personal interests and social care arrangements and evidenced that people had been consulted on such matters and how they would be supported by the home and staff to maintain their preferred lifestyle. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 11 Where an identified risk had been highlighted, there was evidence that the home had taken appropriate action to minimise the risk to the identified person. One example related to a person who was assessed as at risk of leaving the building. The home operates an open door policy and to support this person, the home had consulted with relatives on the use of a piece of equipment, worn by the person, which alerted staff if they left the building. Additional equipment continues to be used by other residents who may get up during the night and need assistance from the night staff. Medication procedures were assessed and found to be in order. A team of designated staff have responsibility for the administration and have received the appropriate training. Records are maintained of medication received by the home and when returned to the pharmacist. Medication is stored securely in the main office and the senior on duty holds the key. There are nine named people responsible for medication administration procedures. On examination of stocks of medication the home is advised to ensure correct accounts of stock are maintained where amounts of medication are carried forward from the previous month. Where staff hand write information on to the medication administration records these should be signed by the person making the entry and also be signed by another member of staff to confirm the entry is accurate and correct. A copy of the home’s policy is also located at front of the medication records. Throughout the day observations were made on the way staff and people living there interacted. There was a positive and professional approach taken by staff when supporting people with staff consulted with people when assisting them. The manager confirmed the home receives significant support from mental health services. This includes a CPN who visits on a regular basis and psychogeriatrician based at Tameside Mental Health at 3-4 monthly intervals. If people need to attend hospital the home will provide an escort service at no charge. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 12 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily and social care arrangements are delivered in a way which reflects the choices and preferences of people. EVIDENCE: People are free to plan how they spend their day, such as what time they get up, where they sit and what activities they want to take part in. It was evident from discussions with people living there, staff and relatives that social care arrangements are an important aspect of life in the home. Staff confirmed that they are given time to sit and talk to residents to seek their views about what they would like to do during the day and where they would like to go on trips out, weather permitting. There was evidence from photos and discussions with relatives and people living there that the home maintains contact with the local community and that trips out are part of planned social events. During discussion with relatives they said the home kept them informed about social events and they were encouraged to attend such events. Relatives also Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 13 said they were made to feel welcome when they visited and were kept informed by staff of health and social care issues relating to their relative. Relatives spoke very highly of the manager and staff team and appreciated the care and support provided to people living there. An entertainer and trips out to a local pub for lunch is planned every 4-5 weeks and is paid for by the owner/manager of the service. The cook confirmed that she receives information from the manager and staff in relation to the medical and dietary needs of people in the preparation of their meals. On entering the dining room a menu board details the choice on offer at each meal. The dining room is pleasantly decorated and tables are set to a high standard. A cold-water dispenser is located as you enter the room. Relatives and people living there complemented the home on the meals provided and said they appreciated the variety and choice on offer. Records are maintained to evidence that range of choices offered. During discussions with two relatives they said “we are well happy with care for the past four years”. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to listen to people’s views about the care they receive. Systems are in place to ensure people are protected from abuse or harm. EVIDENCE: The home keeps a register of complaints it may receive. The home’s procedure is set out in the service user guide, which is located at the main entrance. During discussions with relatives they said they knew who to speak to if they had a concern and many stated they had no concerns about the care provided. The Commission had received no complaints since the last inspection. Comments received from relatives and people living there were that they knew who to speak to if they had a concern about any aspect of care. Formal training has been arranged through the local authority to provide the carers with required information concerning the protection of vulnerable adults. The carers confirmed to the inspector they had received this training. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 15 During discussions with staff they demonstrated a clear understanding of what to do in the event of an allegation of abuse being disclosed to them or being made aware of an abuse issue. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thorncliffe provides a warm, clean and well-maintained environment, with a good standard of furnishings and fittings. EVIDENCE: A tour of the home and its grounds was undertaken as part of this inspection. The home was found to be clean and programmes of decorating and maintenance were well established. This was evident on the day as the maintenance person attended to address identified issues raised during this visit. Bedrooms were found to be personalised and could be accessed throughout the day without restriction. All the furnishings and decoration were to a good standard and gave a homely feel. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 17 The main entrance into the home is via the front door. Visitors are encouraged to sign in and out to comply with the health and safety regulations. The rear garden is fully accessible from the lounge and provided people with a pleasant and secure area to access, weather permitting. Some areas for attention related to the following: The home is advised to ensure double bedrooms are provided with privacy screens. In some rooms the labels on wardrobe and drawer units did not reflect the names of people occupying the room. Also a clock in one room did not accurately reflect the time of viewing. This information should be amended to support people whose primary need for care is a mental health care need. Bedroom 9 was identified as needing decorating, and in a number of rooms the bed head was missing and should be fitted. In room 14 a restrictor should be fitted to the outward opening window. The self closer on corridor door at room 9 was not shutting as the arm was disengaged from the closing mechanism. On examination of the basement the manager is advised to consult the fire service on issues relating to emergency lighting and evacuation procedures as there is only one way out from this area. Some hazardous materials stored in the area should be removed. Some cleaning solutions had been decanted to unlabelled plastic spray containers. This practice required monitoring. The exit route at side of building must be monitored and kept clear as bins obstructed the way out and the kitchen window opened out onto the way out. The dining room had been decorated; a fire evacuation sign had not been repositioned above exit doors. One route from the dining room takes you through a double door to the front of the building. Some equipment, ladders and vacuum cleaners were stored in the area between both doors and obstructed the designated way out. These must be removed and the area kept clear of obstructions. The above issues were brought to the attention of the manager and the maintenance person who said appropriate action would be taken to address these issues. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 18 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive care from a well trained staff team, who have been recruited through a robust selection procedure. EVIDENCE: Information relating to staff cover was assessed for the two-week period covering the inspection and indicated that appropriate levels were being maintained. The staffing structure comprises of the Registered Manager/owner, deputy manager, four senior carers, (one working nights) and 10 care assistants. A cook and domestic/cook is also employed. Staffing levels are well maintained and indicate that in the morning there is a senior, two care assistants and cook on duty. Evening and afternoons are covered by a senior and two carers. The nights are covered by a person on waking duty and one person sleeping in on call in the event of an emergency. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 19 The files of staff recently recruited and their records, reference checks and Criminal Record Bureau (CRB) checks were seen and confirmed to be in place. The files are retained in a secure manner. Staff confirmed that regular staff meetings are held and supervision appeared to take place but was very informal. The deputy and manager were advised to develop a supervision format and to have formal structured supervision sessions with staff and to retain minutes of supervision sessions. The home is also advised to retain recorded minutes of senior and staff meetings. The manager said the staff team offered a consistent and stable work force with very little turnover. Records relating to National Vocational Qualifications were that two staff were currently working to achieve this award and once completed all staff working at the home will have achieved this award. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management and administration procedures ensure the home is run in the best interest of people who live there. EVIDENCE: The registered person, who is also the registered manager, holds the necessary qualification and has a number of experiences in caring for older people. The manager remains very much hands on in relation to delivery of care and supporting staff on caring issues. The manager stated that a system for reviewing the home’s policies and procedures at regular intervals is in place and is advised to retain evidence of annual reviews by dating documents. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 21 The registered person retains small amounts of monies for safekeeping. The money is made available to the home for small expenses, by the resident’s relative or representative, as the registered person has no involvement with the individual finances. All records of expenditure are retained along with the receipts. The records were appropriately maintained in order that the financial interests of the residents were safeguarded. The staff have received the mandatory training in health and safety, first aid, fire awareness and food and hygiene. The maintenance of all appliances and equipment is carried out under contract. The health, safety and welfare of people are further ensured by the systems in place to report accidents and incidents. The home has completed a quality audit and survey of people’s views and was advised to do a summary report of the finding to be included in the homes Statement of Purpose. Discussions were held with relatives visiting at the time. One said she was “very happy with the support and service offered by the home”. Another relative said her relative was “quite comfortable”. Records relating to health and safety checks and checks on the fire system were well maintained as were certificates relating to service of the lift and insurance liability. Waste disposal arrangements were in order. Storage of bins need reviewing, as they are located down a route of egress and may obstruct the way out. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 22 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 X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 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 3 Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Correct accounts of medication carried forward from the previous month, should be maintained. Hand written information on to the medication administration records should be signed by the person making the entry and signed by another member of staff to confirm the entry is accurate and correct. 2 OP19 The home is advised to monitor and address issues identified during this inspection in relation to: Provision of privacy screens in double rooms. Name labels on furniture in bedrooms. Information such as correct time settings to support people whose primary need for care is a mental health Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 24 care need. Door closer and hold open devices. Bed heads on beds. A restrictor should be fitted to the outward opening window in the identified room. Additional advice should be sought from the fire service in relation to matters identified in respect to accessing the basement area. The exit route at the side of the building and internally should be kept clear at all times. 3 OP27 Records should be retained of outcomes of staff meetings and formal one to one supervision sessions. It is recommended that a supervision format is developed and formal structured supervision sessions for staff are provided. Thorncliffe DS0000005590.V364669.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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. 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