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Care Home: Thornfield Care Home [Seaton]

  • 87 Scalwell Lane Thornfield Seaton Devon EX12 2ST
  • Tel: 0129720039
  • Fax: 01297625979
  • Planned feature Advertise here!

This home last had a key inspection in January 2009. Thornfield is a care home that provides care and accommodation for up to 38 residents with needs relating to old age and/or dementia. It is situated on the outskirts of Seaton, in a quiet residential area within driving distance of the town and seafront. The home is a large older style house, which has been converted and extended over the years. The communal areas are well lit and well maintained, and offer a choice of places for people to spend their time. Bedrooms are situated on the ground and first floors. The majority are for single use and some have ensuite facilities. A staircase and a small passenger lift link floors. Outside the home there is parking on the road outside and a garden to the rear. The current fees range from 385.00 to 700.00 pounds. Fees do not include items such as taxi fares and the cost of newspapers or toiletries. Those people who wish to use 2 8 0 1 2 0 0 9 3 0 0 incontinence aids and are not assessed as needing them by the district nursing service pay for their own. Further information about this home is available direct from the home.

  • Latitude: 50.715999603271
    Longitude: -3.0739998817444
  • Manager: Manager post vacant
  • Price p/w: ~
  • UK
  • Total Capacity: 38
  • Type: Care home only
  • Provider: Cannon Care Homes Limited
  • Ownership: Private
  • Care Home ID: 16793
Residents Needs:
Old age, not falling within any other category, Dementia, Physical disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 11th December 2009. CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

For extracts, read the latest CQC inspection for Thornfield Care Home [Seaton].

What the care home does well The home has a good admission procedure, which encourages people to visit and ensures that the right level of information is gathered before someone moves to the home. Medication is well managed with clear records. Attention has been paid to promote people`s choice and maintain people`s dignity by the practice of the staff and the ethos of the home. There is a clear complaints procedure and staff understand their responsibility to respond to concerns and complaints, as well as their duty to safeguard the people in their care. The environment of the home is clean and odour free. Design changes now encourage people`s Independence, and people move freely round the home to find a communal area that suits their mood or purpose. Staff and people living at the home have benefited from a much improved training programme, particularly the focus on high quality dementia care training. The home is committed assessing the quality of their care and involving people living, working and visiting the home in providing feedback on the work they do, as well as reacting positively to suggestions. The home is well run and well maintained. What has improved since the last inspection? The service has worked hard to address the all three requirements from the last inspection, which have now all been met. There have been improvements to the quality of care plans, which helps promote people`s well-being and safety, and provide an accessible and consistent approach to care. People`s health needs are now met in a more affective manner, including their mental health needs, by well trained staff, who are caring and insightful. A greater range of physical and mental stimulation is now provided for people living at the home, which has had a positive impact on people`s well being. As apart of the last inspection, we made eleven recommendations to improve practice and the home has addressed these areas, which included promoting people`s dignity, offering choice, maintaining confidentiality, assessing the quality of care and ensuring that training us updated. What the care home could do better: As a result of this inspection, no requirements have been made. Instead, we have made four recommendations to promote best practice in the areas of monthly reviews, reviewing staff training in end of life care, reviewing the deployment of staff at teatimes and finally a repeated recommendation that the acting manager of the home should be registered with CQC to promote stable leadership at the home. Key inspection report Care homes for older people Name: Address: Thornfield Care Home [Seaton] Thornfield 87 Scalwell Lane Seaton Devon EX12 2ST     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Louise Delacroix     Date: 1 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 34 Information about the care home Name of care home: Address: Thornfield Care Home [Seaton] Thornfield 87 Scalwell Lane Seaton Devon EX12 2ST 0129720039 01297625979 thornfieldcare@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cannon Care Homes Limited care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home This home last had a key inspection in January 2009. Thornfield is a care home that provides care and accommodation for up to 38 residents with needs relating to old age and/or dementia. It is situated on the outskirts of Seaton, in a quiet residential area within driving distance of the town and seafront. The home is a large older style house, which has been converted and extended over the years. The communal areas are well lit and well maintained, and offer a choice of places for people to spend their time. Bedrooms are situated on the ground and first floors. The majority are for single use and some have ensuite facilities. A staircase and a small passenger lift link floors. Outside the home there is parking on the road outside and a garden to the rear. The current fees range from 385.00 to 700.00 pounds. Fees do not include items such as taxi fares and the cost of newspapers or toiletries. Those people who wish to use Care Homes for Older People Page 4 of 34 2 8 0 1 2 0 0 9 3 0 0 Over 65 38 38 38 Brief description of the care home incontinence aids and are not assessed as needing them by the district nursing service pay for their own. Further information about this home is available direct from the home. Care Homes for Older People Page 5 of 34 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: The inspection was unannounced and lasted approximately nine hours. During this time we spent time talking with people who live, work and visit the home. We spent time in the communal areas of the home at different times throughout the day to help us build a picture of what life is like for people living at Thornfield. This included spending time in the dining room at lunchtime, and during this time we used a tool that helps us measure peoples sense of well being and the skills of the staff who support them, as well as seeing how people are engaged with the world around them over a set period of time. This is called a short observational framework for inspection (SOFI). Usually this takes place consistently over two hours but on this occasion it lasted one hour as people were active and used different parts of the building after they had finished lunch so we were unable to follow different peoples activities. As part of the inspection we also case tracked three people. This means that where possible we met with them, talked to staff about the type of support they need and Care Homes for Older People Page 6 of 34 look at the written records relating to their care. We also looked at other records, including recruitment, staff training and incident and accident reports. We visited different parts of the building, including communal areas, staff areas and peoples individual bedrooms. The home looked welcoming and was decorated for Christmas. People living at the home told us about the decorations, and showed us items that they had been involved in making. There was a sense of pride and ownership of the home expressed by many of the people we spoke to. Prior to the inspection, the acting manager completed an Annual Quality Assurance Assessment (AQAA), which provides details about how the home is run. We have referred to this document in our report. We also sent out surveys to people who live, work and visit the home. We had a good response, which included seven from people living at the home, some of whom had been helped by staff or relatives/spouses. Five relatives also sent us completed surveys, as did nine staff members. We have included the outcome of these surveys within the report. Care Homes for Older People Page 7 of 34 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 on page 4. 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 Care Homes for Older People Page 8 of 34 order line 0870 240 7535. Care Homes for Older People Page 9 of 34 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 34 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 have their needs assessed before moving in, so they can be sure that the home can provide an appropriate level of care, and they are encouraged to visit. Staff working at the home have been provided with appropriate training to support people with dementia. Evidence: The homes AQQA states that people and their families are encouraged to visit the home before they move in, and that a pre-admission assessment will take place to ensure that the home can meet their care needs. During our inspection, we saw that a family member for a prospective resident was welcomed by staff and encouraged to look around. The health professional who accompanied them, said that they had arrived unannounced, and had been pleased by the home encouraging them to do this, and by what they had seen during their visit. Later in the day, a senior member of staff visited the person in their own home to begin the pre-admission assessment. We spoke to another health professional who was positive about the admissions Care Homes for Older People Page 11 of 34 Evidence: procedure of the home and their assessment process. They told us that the relative of the person who had moved in had felt reassured and informed by the homes staff. Relatives told us in their surveys that they felt the home provided them with enough information to help them make a decision about the home. Some people living at the home said this was also the case, although some said that they didnt know. One visitor told us that their spouse had not lived at the home long but it is already very clear that the care and attention (they) have received has resulted in (them) being happy and contented. This is far better than I could have hoped and has been a great relief to me. Another told us the home is all that I could expect...all the staff that I have been able to observe are cheerful, caring and treat the residents on a first name, individual, dignified basis. A third visitor said that their relative had been living at the home for eight months and had come on leaps and bounds since being in Thornfield. All the staff said that they usually or always had up to date information about the needs of the people they support or care for. Staff told us how they are given the right level of information to help them care for new people moving to the home. We looked at the care file for somebody who had recently moved to the home. This showed that despite their admission being an emergency, staff had visited them in their own home to assess their needs to ensure that they could meet them, and liaised with the health professional involved regarding their mental health needs. This is good practice. We looked to see if the staff at the home have undertaken suitable training to meet the dementia care needs of the people living at the home. The homes AQAA states that three members of staff have received intensive training in dementia care mapping to help improve the quality of life for people living at the home. Staff who attended this course told us how it had opened their eyes to providing more individualised care for people. We saw from written records details of how they had explained their role in observing practice to other members of staff. Other staff members were also positive about the importance of dementia care mapping and told us that their practice is observed by senior staff to ensure they are supporting people appropriately. They also told us about a one day training course provided by Bradford University, and could describe how their practice and insight had been improved. Our discussion with them highlighted their self awareness regarding the impact of their behaviour on the people they cared for. We saw from records that all staff had attended this training, staff feedback in the form of surveys was positive about this training, and we saw staff from all areas of the home at ease with the people that lived there and responding to them appropriately. Care Homes for Older People Page 12 of 34 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 living at the home benefit from improved care records, which support knowledgeable and well informed staff, although minor changes would help support staff further. Peoples health care needs are well met, and the ethos of the home supports a flexible approach to care that promotes peoples individuality. Evidence: Care planning should provide a foundation to good quality care to ensure that peoples physical and mental well-being is supported in a consistent manner. The last time we inspected we made a requirement for this area of recording to be improved. On this inspection, we looked at three care plans in detail and saw that improvements had been made. We saw that each care plan identified peoples specific needs in a person centred manner. For example, how they liked to have support with personal care, their preferred daily routine and how their mental health and well-being needs should be supported. For example, we saw staff providing encouragement, prompting and reassurance to people throughout the day. Care plans are comprehensive, incorporate peoples views and generally have well Care Homes for Older People Page 13 of 34 Evidence: written and up to date records.They include peoples individual communication needs, and during our inspection we saw staff meeting these needs by checking they had understood or respecting the persons interpretation of events. We also some staff being particularly skilled at responding to peoples non verbal communication and respecting their decisions and requests. We saw staff adapting their approach to different people, recognising when their behaviours impacted negatively on others and intervening in a sensitive manner. We saw that care plans encouraged staff to support peoples independence, and we saw examples of this during our inspection. For example, recognising when people needed assistance with their meals and when people just needed prompting or encouragement. People were given a choice of cutlery during their meal, and when they struggled to use a knife and fork, a spoon was suggested or staff offered to cut food; with staff responding sensitively to peoples preferences. We saw that the care plans are reviewed monthly but these lack detail. For example, we were told that somebodys pressure sore was improving with support from the district nurses but this was not recorded as part of their review. For another person, it was recorded that they had lost weight, a nutrition plan was in place and we saw staff encouraging them with their meal and saw that they appeared to be enjoying their lunch. However, the monthly review did not record whether the nutritional action plan was working and if any further steps needed to be taken. Therefore monthly reviews do not currently provide a robust overview of each persons quality of life and care for each month to help ensure that the home is meeting all their needs. Last time we inspected the home, we made a requirement for peoples health needs to be improved. We spoke to three health professionals during our visit who were positive about the improvements that had taken place within the home and how people are cared for. One told us that the home monitored peoples changing health needs and that they were contacted appropriately. Another told us that their client had responded well to the atmosphere of the home and appeared more relaxed and open to staff intervention than they had expected when they came to review them. They felt the persons improved mental health was due to the increase in staff skills, an attractive environment and strong, positive leadership. Care plans showed us that referrals are made to specialist health care professionals, including GPs, psychiatric nurses and district nurses to ensure that people living at the home receive the support they are entitled to. Visitors told us that the home met the needs of their relatives, and that they are kept up to date with important issues affecting their relative. Care Homes for Older People Page 14 of 34 Evidence: We saw that professional tools have been adopted by the home to manage pressure care and weight loss, and in one of the care files we looked at records to monitor a persons fluid and food intake. This had just been started for someone who had moved to the home, and would have benefited from a target intake to make it more effective. We looked to see how peoples continence is managed. There is guidance in peoples care plans and we saw that a chart had been started for someone who had moved to the home to encourage their continence. The communal areas are odour free, as were the bedrooms, which we checked. A relative told us in a CQC survey that the home is always, upon my visits, odour free. People did not look agitated and peoples clothes were clean and dry, as were the chairs in the communal areas. There has been significant improvements to the signage for communal toilets and the home has followed good practice design to help maintain peoples independence. We saw someone using the toilet sign to reassure themselves that they knew where the toilet was. Staff told us about training they had received in skin care and the aging process, and how they would report any concerns immediately to the senior on duty. Staff told us that cream charts were kept in peoples room, and that these were checked by senior staff to ensure they were completed. We saw certificates for training in this area of care in staff files, and saw that pressure relieving cushions were available around the home and that people were using them. The care plan for a person with vulnerable skin stated that a pressure cushion must be provided for them. Staff told us that training in the aging process had been helpful, as had continence management training. We looked to see how people are cared for to support their physical health. We saw from records that peoples weight is monitored on a regular basis, and that staff training covers areas such as diabetes. And that people involved in food preparation have qualifications in health and social care, and could tell us about how food should be prepared for people with specialist preparation needs. Throughout the day we saw people being provided with drinks and encouraged to drink. We were told that fresh fruit is offered daily, and that Bowen therapy is provided on a monthly basis to promote a healthier lifestyle. We looked at the way medication is managed in the home. We observed a medication round, and saw that medication was safely transported around the home with the trolley locked each time the staff member left it. The staff member was calm and methodical in their approach, and ensured that people had taken their medication Care Homes for Older People Page 15 of 34 Evidence: before they left them, which shows good practice. There are good systems in place to promote safe practice which can be audited, such as a list of staff initials and staff double signing for handwritten additions. Medication sheets were accompanied by a photograph of each person living at the home and records were completed with no gaps. A staff member told us about their role in monitoring the management of medication and the training they had received. We saw the training certificates in their staff file, discussed with them how they managed storage temperatures for medication and what steps they would take if they had concerns. We checked the controlled drugs within the home, and saw they were securely stored and accurately recorded. We saw that guidance is in place for PRN drugs and heard from the acting manager that this is work in progress and that more detail is being added to ensure they are used appropriately. We met with someone who suffered pain in their knees and they told us that staff rubbed in cream to help with the pain and that they had been provided with a walking frame to help them move around. We looked to see how peoples dignity is maintained, both through their environment and the practice of staff, which effects peoples sense of well-being. We noticed that during this inspection people seemed much more relaxed in their surroundings and more open to conversation and spending time with others. Throughout the inspection, we saw some people striking up conversation with each other and finding places to sit together and chat. We spoke to people individually, and in pairs and spent time watching the life in the lounges and the dining room. People moved around the home with confidence and people were rarely anxious about their surroundings as they moved about but appeared to be exploring and discovering areas. Improved signage, lighting and attractively designed communal areas, which now flow into one another enables people to move around and lessens disruption for others. We saw staff monitoring peoples use of a communal toilet in a discreet manner. Most of the time, staff made time to listen to people and respond to their requests, giving them eye contact supported by physical or verbal reassurance. Relatives told us that the staff are very caring and friendly to all, interact with residents - frequent personal contact and that staff communicate very well with carers/relatives. Peoples dignity was maintained by their appearance. For example, we saw that many women living at the home wore co-ordinating clothes with matching jewelery, and had manicured nails. One person told us how much they liked having their nails done. One of the care plans we looked at recorded that the person should be supported to choose Care Homes for Older People Page 16 of 34 Evidence: their own clothes each day in recognition that their appearance was important to them. The person seemed low when we spoke to them but then brightened when we talked about clothes and they told us about and showed us their new shoes. We later heard them discussing their shoes with a friend, which showed a sense of pride and well-being. Many of the women in the home have handbags with them and staff ensured they were not left behind as they moved around. We met a visitor who told us that their relative was wearing their own clothes and that the laundry now ensured that socks were not mislaid. Minutes from a staff meeting reminded carers to ensure that peoples hands and faces were clean before they left the dining room, and we saw this happening at lunchtime, and carers reassuring people that clothes could be changed if they had become stained during their meal. Staff offered protective clothing in a sensitive manner and ensured that nobody was left wearing them after the meal. The home s AQAA supplied us with details of the number of people who have received end of life care at the home, which we checked with the management team, who provided us with further information. We were told that the home aimed to offer a home for life where possible. During the inspection, we were told there was no one currently receiving this form of care. The management team told us that senior carers who have experience in this area of care support less experienced members of staff, and provide a positive role model. Currently this training is not recorded. We saw feedback from a visitor, which praised the quality of end of life care that was provided for their relative. We looked at three peoples care plans to see how peoples last wishes are recorded i.e. resuscitation decisions and saw that these currently do not reflect the good practice within the Mental Capacity Act. Care Homes for Older People Page 17 of 34 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 benefit from significant improvements from the choice of the activities, opportunities and meals that are offered to them. Evidence: The homes AQAA describes the activity staff as competent, enthusiastic and understanding of the residents needs. We saw examples of this during our inspection with staff altering their approach to different people, recognizing who wanted to get up and dance and who wanted to make Christmas decorations or look at books or sit and watch others. We heard different types of music from different years being played throughout the day. One person sang along to Frank Sinatra at lunchtime and another danced to seventies disco music with staff. Staff members were supportive with this activity and recognised the enjoyment of the person, whose face lit up while they danced . We saw some people enjoying using percussion instruments to play in time with music. While other people responded well to a balloon game or sat commenting on the television. Some people dozed but they were very much in the minority, and one person said they preferred the peace and quiet of one lounge. Staff regularly checked with people whether they wished to have a drink or whether they were comfortable. Care Homes for Older People Page 18 of 34 Evidence: People living at the home seemed at ease in their surroundings, finding places where they preferred to sit. Some people took an active part in games and tasks around the home, such as folding the laundry, while others seemed to prefer watching what was going in the home. From some people, we drew a great sense that they felt ownership of the home and their place in it, which showed a positive sense of well-being. We saw people helping with folding the laundry, while another person had a quick chat with chef to find out what they were doing and a third person went round and drawing the curtains in the dining area when it became dark outside. We heard people telling each other about where they lived in the home i.e. Im just next door and Ive popped out. People told us about the garden , which now has raised planters in it, and are used by people living at the home to grow vegetables. People commented on the weather and the surroundings outside of the home, and talked about the homes shop and what they wanted to buy. We met a person who said they preferred their own room where they were sat facing the window as they looked at their newspaper. They were very proud of their room, with a strong sense that it belonged to them and told us about the history of the furniture, and the comings and goings of people in the street. The AQAA records trips out to different museums catering for men and women, including a meal out. The home did have access to a mini bus but this is not the case at the moment and we saw from staff surveys that they have asked for this be addressed and for a meeting to plan further activities and trips. One persons care plan said that they liked to be read to by staff, this was particularly relevant as they were unwell and being cared for in their room. Their activities records did not reflect this happening but we were told this type of care was provided by care staff who did not write in these records but that this would be amended. Another persons care plan recorded that they liked ballroom dancing and we discussed with acting manager how this interest could be addressed. Records show that there has been a range of activities, including people living at the home involved in cooking, a visit from the donkey sanctuary, and visiting musicians. Staff told us how food is prepared to reflect and celebrate the changing seasons. People that we spoke with seemed generally satisfied with how they spent their time, and relatives told us that the home provides opportunities for residents to participate in activities, which is vitally important. Another person told us that participation in activities is encouraged by staff and people living at the home told us in their surveys that the home always arranges activities that they can take part in, although one person said they also enjoyed the option of peace and quiet. Care Homes for Older People Page 19 of 34 Evidence: We were told that visitors are encouraged to arrive unannounced, whether they are relatives or health and social professionals, which we saw on the day of our inspection. Visitors were made welcome by staff, and we heard refreshments being arranged. People visiting the home said they could chose where they met with their relatives and that changes were made to support these decisions, such as where people ate their meal and what type of meal was provided. We saw letters from relatives praising the homes summer fayre and we saw a poster for a Christmas event which family and friends were invited to. There was a recognition by staff in the importance of involving relatives and the feelings they may experience and the reassurance they may need. We spent time in the dining room for both a lunchtime and a tea time meal. Tables were attractively set with space between them so that people had space to move around, and people appeared comfortable and generally at ease. We saw that staff knew peoples individual likes and dislikes, and responded appropriately to peoples individual requests whether it was for alternative food and drink or for reassurance or for help. This was also confirmed in our discussions with staff and in written records. Staff were busy throughout both meals but at the lunchtime meal the atmosphere was generally calmer and people chatted to one another or just seemed happy eating their meal. However, at tea time some people looked more tired and restless, staff were busy but less able to meet the requests of people. For example, there were delays in serving meals and some people were not served in order of arrival, which resulted in one person becoming agitated and frustrated, which had a negative affect on others around them. People told us during the inspection and in their surveys that they liked the meals, and this was confirmed by peoples responses as they ate. Staff who prepare food told us how they meet with people living at the home, to gain feedback and to talk about choices and preferences. They could give us examples of how peoples individual needs are catered for, including cooked breakfasts, and written records supported this discussion. Care plans also detailed peoples preferences, and when we spoke to care staff they knew the details of these. The homes AQAA states that new menus are being introduced and will be reviewed with the people living at the home. Care Homes for Older People Page 20 of 34 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 benefit from an approachable management and staff team, who listen to them. Evidence: Since the last key inspection, we have received an anonymous complaint about the service relating to choice. The home provided a detailed and prompt response to this complaint with no further action being taken by CQC. In the homes AQAA, it is recorded that there have been two complaints since the last inspection and that these were both resolved within 28 days. People living at the home and visiting Thornfield told us in their surveys that they can speak to someone informally if they are unhappy and that they knew how to make a complaint. One person commented favorably on the ease of contact with management. The AQAA states that there is an open door policy. Staff told us in our surveys that they knew what to do if someone was unhappy or wished to make a complaint, and discussion with staff confirmed this knowledge. We saw during the day that usually staff had time to pick up on peoples negative comments, apart from at the teatime meal, and addressed them appropriately. For example, one person was unhappy with the noise of another playing an instrument and the staff member intervened sensitively and quickly to resolve the problem. The homes AQAA states that safeguarding training is provided for all staff, is now included as part of induction training, which staff confirmed. Staff training records Care Homes for Older People Page 21 of 34 Evidence: showed that training is provided in this area. In discussion, staff were clear about their responsibilities and their duty to protect the people in their care. One staff member said it helped to have the policy so clearly displayed, which we saw during our inspection. Care Homes for Older People Page 22 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a clean, odour free and well maintained home that is designed to offer them choice and supports their independence. Evidence: According to the homes AQAA, there have been a number of changes in the last twelve months to the homes environment. This was confirmed in our discussions with staff, and people living, visiting and working at the home. There have been significant improvements to the appearance of the home, both externally and internally, as well as to the layout of the communal areas. These improvements have been made to help compensate for peoples mental impairments. From our observations during the inspection and from our discussions with staff about the environment, it became clear that the changes have helped people retain their independence. For example, we observed someone walking up to a brightly painted communal toilet door. They stopped looked at the specialist picture sign and then pointed at the written sign, and said out loud thats the toilet. They opened the door looked in, and then said I know where it is but I dont need it now. Communal toilets have been designed to help prompt people to use them independently. We observed during our inspection that no one appeared uncomfortable, or had wet clothing and seats around the home were dry. People were supported discreetly with their continence needs and there were no unpleasant odours relating to incontinence. Care Homes for Older People Page 23 of 34 Evidence: Communal toilets are well situated and are kept clean. We also staff supporting people to use the toilets in their own rooms to promote their dignity and privacy. Considerable thought has been invested into viewing the environment from the perspective of the people living at the home. Communal areas now flow into one another, and people were seen to move around the home in a confident manner choosing different places to sit. Several people looked as if they were enjoying watching the world go by from their seats in the hallway, one of whom was praised by staff as being chosen as a comfy lap for one of the homes cats. Later, one of these people joined us in the dining area as we looked at written records. They sat near us looking through a file containing their life story, and seemed relaxed in their posture and body language. Other people were seen choosing to sit with friends, and we heard people talking about their rooms in the context of being neighbours. We visited a person who told us they chose to spend time in their room but that sometimes their neighbours visited them and staff brought them tea. This happened during the afternoon of our visit. The dining room is now based in a room with views onto the garden. During the lunchtime meal, we saw two people sitting at the table pointing at birds in the garden as they waited for their meal. Two other people chatted to us about the area surrounding the garden, and showed an active interest about the the location of the home. We talked to people about the garden and staff told us about the benefits of the raised flower beds and the vegetables that had been planted and grown during the summer. The home has also invested in a potting shed and a range of garden furniture. The homes AQAA states that more handrails will be erected to increase the accessibility of the garden, which is well maintained. There are a range of communal areas, including two lounges, a large attractive refurbished conservatory and a bright and well furnished dining room. Tables in the dining room cater for people using wheelchairs, there is room for people to move around and they are attractively set with tablecloths and place mats. There are fresh flowers around the home and a range of pictures catering for different tastes, such as black and white film stills, which people commented positively upon. The home has invested in specialist lighting, which stimulates daylight, in two of the lower corridors. This makes these areas brighter and more attractive places to use. Staff commented that people living at the home seemed happier to use these areas independently, and we saw this during our inspection and noticed people stopping, looking and commenting on the retro food adverts on the walls. Care Homes for Older People Page 24 of 34 Evidence: The home is clean and maintained to a high standard through the employment of an efficient domiciliary and maintenance team. For example, we saw on-going cleaning throughout the day, so that any spillages are cleaned up quickly and all areas are kept clean. People visiting the home told us this was always the case and surveys returned to CQC confirmed this.The homes AQAA states that there is an on-going maintenance programme, which includes further investment in specialist lighting and improvements to the kitchen. Staff said they hoped this lighting would be adopted throughout the home because of its success. Care Homes for Older People Page 25 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from being cared for by a knowledgeable and caring staff group, who are recruited in a robust manner and at appropriate levels, and who have access to high quality training. Evidence: The homes AQAA states that 37 staff are employed over all departments. On the day of our inspection, the level of staffing met peoples needs, six care staff were on duty in the morning and were supported by a team of domiciliary staff, which included a cook. These teams are lead by the acting manager and deputy manager. Staff told us they provided positive role models. The role of the activities coordinator means that even when care staff were busy meeting the ranging needs of people living at the home, there was someone to spend time with groups of people or individuals to offer mental and physical stimulation. We saw that the staff team across the home have a range of skills and experience but what was notable that whatever their role, staff communicated well with the people living at the home and appeared at ease with them. The homes AQQA states that agency staff have been had been used in the last three months, and staff said the staffing team has been stable, although some suggested in their surveys that more staff needed to be recruited and one person felt that the management team could be more hands on if staff were off sick. Care Homes for Older People Page 26 of 34 Evidence: Throughout the day, staff were busy but generally communicated well with one another, and the people they were supporting. For example, we observed a member of staff making sure that their team leader was aware of who had eaten well and who needed additional support before they left the dining room. Staff were able to change their approach to meet the different needs of individuals, and showed compassion and an understanding of peoples individuality when they spoke about the people they cared for, although on a few occasions one staff member resorted to directive instructions, which opposed the more person centered approach. We spoke with a visiting professional who felt that the standard of spoken English had improved amongst the staff group and felt that that the staffing levels were appropriate, and that a knowledgeable senior was always on duty when they called. Looking at the responses from relatives to the homes quality assurance surveys, there was a common theme of praise for the friendly and helpful staff. People commented on their kindness and considerate approach, with nothing being too much trouble and staff are unfailing courteous and attentive. This theme was echoed in the responses to the CQC surveys and during our visit several people living at the home told us that staff were lovely. One person told us they liked the atmosphere of the home because I can do whatever I like. Another person told us all very kind staff and helpful, nothing too much trouble...I am very happy with everything, and a third said I like it all. When we looked at how people living at the home interacted with staff, we saw that they were relaxed and at ease with them. People were not afraid to make their wishes known and staff responses showed they knew individuals well, which was confirmed in our discussions with them and in the information recorded in care plans. One relative commented that there had been a noticeable improvement in the well-being of their relative, and this view was repeated by a visiting health professional who had been involved in moving someone else to the home in an emergency. The homes AQAA states that over fifty percent of permanent care staff hold an NVQ 2 in Care or Health and Social Care, which is a good achievement. In our discussions with staff, they confirmed their qualifications as did their training records. We looked at the recruitment files for three staff who have joined the home since our last inspection. There was a clear recruitment process, including appropriate timing for POVA First checks and Criminal Record Bureau Checks (CRBs), with gaps in employment history explained, interview notes, identification and two written references. We discussed with the acting manager the need to record clearly why Care Homes for Older People Page 27 of 34 Evidence: particular referees had been chosen for written references. For example, a deputy manager rather than a manager. However, the home were able to explain their approach during our discussion but just needed to record this decision. Since the last inspection, the home has significantly invested in training for their staff, which has had a positive outcome both for the people living at the home (see evidence throughout the report regarding peoples well-being) and the staff group. Details of training were recorded in the homes AQAA, were described to us by staff and the outcome was observed during our inspection. One staff member said that the training opportunities had been amazing in the last six months, and staff told us in their surveys that the training and induction they received enabled them to meet the needs of the people they cared for. Staff were able to tell us about the positive impact that the dementia awareness course had made on their approach to their role. Staff were extremely positive about the power of the dementia care mapping tool that was used by three trained staff members as they felt it gave them insight into peoples day to day lives and experiences. Some staff requested in their CQC surveys that this level of commitment to training by the owners continued. This commitment would be appropriate for future staff. Staff also told us that they were update to with mandatory training and records confirmed this. We were told by the management team that improvements had been made to staff induction, and a new member of staff was able to describe in detail the type of support they had received and the level of monitoring of their work before they worked alone with people living at the home. Care Homes for Older People Page 28 of 34 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. There have been many changes to the management of this service, and this continues. However, the current management team have shown a commitment to ensure that the home is run in the best interests of the people living there and improvements are on-going. Evidence: The home has had a number of management changes. Staff, we spoke to, were positive abut the management arrangements at the home and felt that despite the acting manager being replaced by her deputy there would still be consistency in the way the home was run. They felt this was because both managers worked in a similar way and had made the changes together. However, a relative we met said that they felt let down by yet another change of manager. They commented this would be the sixth manager in the last two years and said that relatives were regularly assured that there would be stability which then did not happen. They had been upset by the poor practice highlighted by the BBC programme when Gerry Robinson had initially visited the home, and they told us this had left them feeling anxious, especially because of Care Homes for Older People Page 29 of 34 Evidence: another change in the leadership. A visiting health and social care professional told us that there had been significant improvements in the running of the home since our last inspection. They told us that the change in the atmosphere had been revolutionary. They described that people were engaged with the world around them and each other, and that staff were listening to them. They told us that other professionals were commenting positively on the change, which was confirmed when we met with other health care professionals. Staff told us in their surveys that there had been a number of improvements in the atmosphere of the home. Staff gave a range of reasons for the improved ethos in the home, such as better training opportunities, good role models from the management team, greater staff stability and an improved environment for staff and the people living at the home. Staff told there was better teamwork, better planning to meet the needs of people living at the home, and a re-occurring theme was the support provided by management. For example, one staff member said the change at Thornfield over the last six months has been considerable. Lots more ambiance, more activities and staff working much better together to give the best care for our residents. Another staff member said that the home has greatly improved over the last few months and is continuing to do so. Cannot ask for more than that. During the inspection, we talked with the management team about how they monitor the quality of the service. We were told by the management team that there was ongoing work to keep families informed of changes within the home, and that social events had helped build relationships, which feedback from relatives demonstrated. The homes AQAA states that monitoring visits take place in line with the Care Standards Act. Staff could give us examples of how feedback from people living at the home had changed practice, for example changes to meals and displaying the names of staff of duty. We read the minutes from meetings with people living at the home, and saw examples of how people can influence the service. We also read the responses from the homes quality assurance surveys, and saw positive responses. We discussed how this information could be fedback to the people who have completed the survey. One respondent to our CQC survey said they would like to have a newsletter from the home. The AQAA states that peoples personal money is dealt with by one member of staff and then checked by another. Staff confirmed this approach and explained how receipts are kept for any purchases or services. Staff told us that supervision sessions have started and that team meetings take place Care Homes for Older People Page 30 of 34 Evidence: regularly, and we saw the minutes for these meetings, which promoted good practice and person centred care. The main office for the home is now located on the first floor and we saw that records are kept more securely. As part of the inspection, we looked to see how practice within the home keeps people safe. Staff were positive about the role of the maintenance team who respond quickly to work that needs to be carried out to maintain the building. During our tour of the building, we spot checked six individuals rooms and saw that radiators were protected and windows restricted to help keep people safe. We saw that people were moved in a safe manner, and staff records showed that training in this area of care was up to date, which staff confirmed. The homes AQAA states that staff have had training in infection control, and staff practice during our inspection confirmed this as did staff explanation about how practice at the home maintained good infection control procedures, including providing paper towels and liquid soap in peoples rooms. The homes AQAA confirms that the homes policies are up to date and that equipment has been serviced on a planned basis, which a spot check of paperwork confirmed. Care Homes for Older People Page 31 of 34 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 32 of 34 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 1 7 The content of monthly reviews should be reviewed to ensure that they provide a robust system for measuring the quality of peoples care. Training records and supervision sessions should be used to measure staff confidence and experience in providing end of life care, and appropriate action taken to meet peoples training needs. Staffing levels and the way they are used at mealtimes should be reviewed to help maintain a calm atmosphere. The acting manager should be registered with the CQC as soon as possible to provide stable leadership at the home and to indicate a commitment by the owners to retaining the current management structure in order to reassure and provide continuity. 2 11 3 4 15 31 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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