Care Home: Thornhill Care Home

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What the care home does well The atmosphere on the day of the visit was warm and friendly and people looked comfortable whilst sitting in various parts of the home. People living at the home are offered a range of activities and are able to make their own choices about how they spend their time. As a tribute to the standard of food provided the home has received a three stars, "Good" award in association with Kirklees Council`s Health Choice Award. "Scores on the doors". The award is a five star rating scheme providing information about the standards of hygiene and compliance with legislation in food premises within Kirklees. Sixty three per cent of care staff have a National Vocational Qualification level 2 in care and qualified staff have a better understanding of peoples needs. What has improved since the last inspection? Following the last inspection, there has been refurbishment and redecoration of a number of bedrooms, and new floor coverings in several communal areas and bedrooms. Staff now have regular supervision, which ensures that they are supported and competent to do their job. A new care planning system has been introduced so that people`s needs are recorded in more detail. What the care home could do better: Wherever possible the care plan should be drawn up with the involvement of the individual and /or their representative (if any) and should be signed by the individual and/or their representative. The daily record should show that the needs of the person have been met, and if this has not been possible, an explanation as to why should be recorded. Further information needs to be added where gaps have been identified in an individual`s assessment, care plan and risk assessment. Steps should be taken to ensure that medication is labeled with the date of opening where necessary, and discarded within the correct timescales. A risk assessment should also be carried out prior to restrictors being removed from first floor windows to ensure no one is at risk from falling out of the window. Key inspection report Care homes for older people Name: Address: Thornhill Care Home 6 Thornhill Road Huddersfield W Yorkshire HD3 3AU     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: Karen Summers     Date: 2 9 0 6 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 26 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 26 Information about the care home Name of care home: Address: Thornhill Care Home 6 Thornhill Road Huddersfield W Yorkshire HD3 3AU 01484421287 01484546787 thornhill@hillcare.net www.hillcare.net Hill Care Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Shelagh Reilly Type of registration: Number of places registered: care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 1. The registered person may provide the following category of service only - Care Home only - Code OP Care Home with Nursing Code N to service users of the following gender - Either whose primary care needs on admission to the home are within the following categories Old age not falling within another category - Code OP 2. The maximum number of users who can be accommodated is 42 Date of last inspection Brief description of the care home Thornhill Care Home provides both personal care and nursing care for up to 42 older people. The accommodation is in either single or shared rooms. The home consists of an original building with an extension and an additional modern building linked by a spacious corridor. Thornhill Care Home is approximately two miles from the centre of Huddersfield and is close to a bus route. There is a parking area to the front and rear of the home, plus ample on street parking. The main access to the home is via a flight Care Homes for Older People Page 4 of 26 Over 65 42 0 Brief description of the care home of steps but there is level access to the rear of the building. The provider informed the Commission for Social Care Inspection on 29/06/09 that fees range from £434.30 to £684.77 per week. Additional charges include hairdressing, private chiropody, and newspapers. Information about the home and the services provided are available from the home in the statement of purpose and service users guide. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. The date of the last inspection was 01/07/08 This report refers to an inspection, which included an unannounced visit by two inspectors on the 29th June 2009, commencing at 9.50am, and the length of the inspection was 5.5 hours. There were 37 people living at the home on the day of this visit. As part of the inspection in order to provide information to help us form judgments about the quality of the service, the manager was asked to complete an annual quality assessment (AQAA) document. This she did, and the document provided the Care Care Homes for Older People Page 6 of 26 Quality Commission (CQC) with a lot of information about the way the home is run, and what they hope to achieve in the future. To enable people who use the service to comment on the care it provides, we sent surveys to ten people living at the home, one of which was returned, ten to staff, five to local doctors and health care workers (social workers, community nurses), none of which were returned. We focused on the key standards and what the outcomes are for people living in the home, as well as matters, which were raised at the last inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. We would like to thank all people who gave feedback about the home, and would like to thank the manager and staff for their co-operation on the day of the visit. Care Homes for Older People Page 7 of 26 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. Care Homes for Older People Page 8 of 26 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed prior to them moving into the home to ensure that their needs can be met. Evidence: Records relating to three people living at the home were examined, including those of two people who had recently been admitted. There was evidence that a pre admission assessment had been conducted in all the records examined. There was excellent detail about the individuals needs in two of the records seen including evidence that individuals and their families had been involved in the pre admission assessment, however some assessment information was missing for one person and it was not clear who had been involved in the process. This was discussed with the manager at the time of the visit and she agreed to address this. The manager explained that a new format had recently been introduced to the home and staff were still in the process of getting used to this. Care management assessments and care plans were in place in each of the files looked at. Care Homes for Older People Page 11 of 26 Evidence: People who were spoken with said that they had been given sufficient information before they moved into Thornhill Care Home, to help them decide if this home was the right place for them before they moved in. This was also confirmed by a relative who completed the survey on behalf of their relative. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are generally met. Medicine management is mostly good however could be improved by ensuring manufacturers instructions are always followed correctly. People are treated with respect. Evidence: Since the last inspection a new care planning system has been introduced to the home. The home manager explained that they were still in the process of transferring all peoples records onto the new system. Three care plans were examined and two contained detailed information about how peoples needs should be met, however gaps were identified in the third. The home manager agreed to revisit this care plan to ensure that it was completed in full. Some parts of one care plan had not been signed by the staff member completing it, the person or their representative and a recommendation has been made in respect of this. Relevant risk assessments were in place in all the records examined, including falls, pressure care, nutrition and continence. Most of these documents had been signed by the relevant people, although not all. This was pointed out to the home manager at Care Homes for Older People Page 13 of 26 Evidence: the time and again she agreed to address this. Most of the risk assessments contained good, clear information about how identified risks should be managed. More detailed information is necessary in one risk assessment regarding how an individual should be assisted with mobilising and this was discussed with the manager at the time. Evidence was seen in the records that care plans and risk assessments are reviewed on a monthly basis. Daily records are kept with information about how peoples needs have been met. The information in the daily records for two people did not demonstrate that their needs had been met as agreed in the care plan. The care plans clearly stated how often baths should be offered, however the records did not contain sufficient detail to demonstrate whether or not this identified need had been met. The home manager explained that people were being supported to have a bath when they wanted one, but accepted that the records did not clearly demonstrate this. If an individuals identified need has not been met for any reason, an explanation should be recorded. People are supported to have their healthcare needs met and there is evidence that advice is sought from the appropriate healthcare professionals and appointments are recorded in peoples notes. People who were spoken with said that they received the medical care that they needed and this was also confirmed in the surveys. Medication for three people was examined. The home uses a monitored dose system, and regular audits of the medication are carried out; evidence of this was seen in the records. All medication examined tallied with the records kept. Two bottles of eye drops for an individual were seen. The instruction states that both must be discarded within a set period of time after opening. One was found not to have been labeled with the date of opening, and one was being used after the date by which it should have been discarded. This was addressed at the time by the service manager. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are offered a range of activities and are able to make their own choices about how they spend their time. Meals provided are good, varied and served in a pleasant environment. Evidence: An activities person continues to be employed by the home for 16 hours a week. The information received from the manager prior to inspection states that this person, Is dedicated and enthusiastic in the homes provision of stimulating and interesting activities and pastimes for people who live there. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their complaint will be listened to and acted upon. Staff have received suitable training and understand the adult protection policies and procedures, which makes sure that the people they support are safe. Evidence: The Complaints procedure is located on the wall in the entrance of the home. The procedure specifies how complaints may be made, and with an assurance that they will be responded to within a maximum of 28 days. There is also a whistle blowing procedure, and staff confirmed that they knew the procedure. Without exception all staff said that they would know what to do if someone wished to make a complaint. People who use the service said that they knew how to make a complaint and knew who to speak with if they were not happy. People who use the service also said that they knew how to make a complaint. The manager keeps a log of any complaints received and there was evidence that two complaints had been received in the last twelve months, and that the appropriate action had been taken. Letters and cards of compliments were also seen from grateful relatives/ friends and Care Homes for Older People Page 16 of 26 Evidence: people who had received care at the home. Staff training records were seen and showed that staff had attended safeguarding (adult protection) training and those staff spoken with during this visit knew how they would report poor care practice and abuse. They were also aware of the Whistle blowing procedure. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers people a homely and comfortable environment. Evidence: As part of the inspection a tour of the home took place, which included the communal areas, a number of bedrooms and the laundry. The atmosphere on the day of the visit was warm and friendly and people looked comfortable whilst sitting in various parts of the home. Ongoing refurbishment continues to take place, and includes the purchase of new floor coverings in several communal areas and bedrooms. There has also been refurbishment and redecoration of a number of bedrooms and this was confirmed in the information received prior to the inspection. Within the main up stairs lounge some of the chair arms were showing signs of wear. The Operations manager said that the chairs had been identified to be replaced within the redecoration programme. In three of the bedrooms that were inspected, window restrictors were either missing or the window was propped open. The maintenance person said that he had just removed the restrictors to enable access to the roof. This was discussed with the Care Homes for Older People Page 18 of 26 Evidence: manager and the need to ensure that no one is at risk of falling out of the window. The maintenance person said that the work would be carried out and he would replace the window restrictors. The manager also confirmed this and that she would ensure that no one was at risk. The maintenance worker is employed 20 hours per week and the company also employs maintenance people to carry out the decorating within the home and this was confirmed by the manager. The standard of cleanliness was good however; there was one bedroom where there was an odour of which the manager could demonstrate that steps had been taken to address the situation. People who were spoken with said that the home was usually clean. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of staff to meet peoples needs. Staff receive training to assist them to carry out their responsibilities and they have had all the necessary checks before working with people so they are kept safe. Evidence: There were thirty seven people in residence, and the duty rota confirmed that there were sufficient staff on duty to care for the number of people living at the home, and the manager also confirmed this. People receiving care said that staff were available when they needed them. A relative made the comment, There are usually staff about when you need them. Care practice observed during this visit, and the relationship between staff and people being cared for was positive. Sixty three per cent of care staff have a National Vocational Qualification level 2 in care, and qualified staff have a better understanding of peoples needs. Samples of recruitment records were inspected and the correct information and checks had been carried out. There was also evidence in the staff records and staff confirmed that they had induction training, first aid, fire, infection control, and movement and handling training. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from the management approach of the home and the manager ensures so far as reasonable practicable that the health, safety and welfare of people and staff are protected. The home is run in the best interest of people who live there. Evidence: The manager is a Registered Nurse and also has achieved the Registered Managers Award. Opinion surveys have recently been carried out from the home, and when collated, the manager said that the results of the surveys would be displayed in the entrance of the home for people to see and discussed at the residents/ relatives meeting. The Regional Manager and Operations Director were also visiting at the time of the inspection, and the homes Manager confirmed that she received support from these managers. Care Homes for Older People Page 21 of 26 Evidence: The Regional Manager writes a monthly report of her visits that is used to monitor the quality of the service. Evidence in staff files showed that regular supervision of staff has commenced and staff confirmed this. Staff also confirmed that they had regular fire drills and training however, when the training records were looked at it was noted that two staff were due an update lecture. The manager assured us that these people were to have update training on the 30th July when the next training was booked. A sample of records was looked at relating to health and safety within the home and satisfactory records are being maintained. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 In order to ensure that peoples needs are met, each person living at the home should have their needs thoroughly assessed, and a record of this should be kept. The records should demonstrate who has been consulted as part of the assessment process. The daily record should show that the needs of the person have been met, and if this has not been possible, an explanation as to why should be recorded. Wherever possible the care plan should be drawn up with the involvement of the individual and /or their representative (if any) and should be signed by the individual and/or their representative. Steps should be taken to ensure that medication is labelled with the date of opening where necessary, and discarded within the correct timescales. Guidance should be available for staff when as required medication is to be given. 2 7 3 7 4 8 5 19 A risk assessment should be carried out prior to restrictors being removed from first floor windows to ensure no one is Page 24 of 26 Care Homes for Older People 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 at risk from falling out of the window. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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