Care Home: Thornton Lodge (105)

Similar services:

• Townley Road, 2-3
• Foxley Lane (121a)
• Tudor Lodge
• Stacey Street Nursing Home
• Delrose House Ltd
• Clovelly House Residential Home Ltd
• Abbey Road [53]
• Cherry Tree House

What the care home does well Prospective residents are being provided with all the information they require, and the opportunity to visit, before deciding whether the home is likely to meet their needs. Each resident is being provided with a copy of the Home`s terms and conditions at the point of moving into the home. Residents are having their health, personal and social care needs and goals set out in an individual plan of care, and are being involved in the care planning process. Residents are being protected by the home`s medication policy and procedures. Accredited medication training is being provided for all care staff who administer medication. Residents are being treated with respect and their privacy is being maintained. Residents can be assured that, at the time of their death, staff will treat them and their relatives with care, sensitivity and respect. Residents are being provided with a varied range of socially and culturally appropriate recreational and social activities. Residents are being assisted to exercise choice and control in their daily routines, activities and decision-making. Residents are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Residents receive a wholesome, varied and balanced diet in pleasant surroundings. Residents and their relatives can be assured that the home has an appropriate complaints policy and procedure in place, and that their complaints will be listened to, taken seriously and acted upon. Clear information for raising complaints is made available, and residents and their relatives/friends are encouraged to raise any concerns that they may have. The legal rights of residents within the home are being protected and promoted. The home`s policies, procedures and training are helping to ensure that residents are being protected from abuse. While staff at the home are assessed to be meeting the needs presented by the home`s residents, any further increase in their numbers will, if safety is to be assured, necessitate an increase in the staffing level on duty. The home`s residents are being protected by appropriate recruitment policy and procedures, including employment and criminal records checks. Generally, staff are being provided with the necessary induction and training with which to perform their work duties competently, and to safely meet the needs of residents. Residents live in a safe, well-maintained environment, with access to safe and comfortable communal facilities. Residents have sufficient and suitable toilets and washing facilities. Residents` rooms are safe, comfortable and pleasantly decorated, reflecting residents` personal identities, and being suited to their individual needs. The home presents as being clean, pleasant and hygienic. All staff at the home receive infection control training. What has improved since the last inspection? All care staff have now completed training in two key areas: Working with service users who present mental health problems; and Working with service users who present challenging behaviour. A development plan, for quality assurance purposes, has been put in place. Health and Safety, and Environmental Health, have completed inspections of the home in 2007. Two senior care workers have completed Croydon`s `Training for Trainers` course in adult protection. All the home`s policies and procedures have been reviewed (in July 2007). There has been some delegation of the supervision workload, with two senior care workers having received training, and now assisting the manager in supervising staff. What the care home could do better: Generally, the home is able to demonstrate that the range of needs presented by residents are being properly assessed, and appropriately met. However, a number of care reviews, to assess the suitability of the placement, have not been completed following the initial six to eight week period after admission. The job description, for the two senior care workers who undertake supervision, should include reference to this responsibility. All care staff must receive an annual appraisal. CARE HOMES FOR OLDER PEOPLE Thornton Lodge (105) 105 Brigstock Road Thornton Heath Croydon Surrey CR7 7JL Lead Inspector Peter Stanley Key Unannounced Inspection 20th and 21st November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thornton Lodge (105) Address 105 Brigstock Road Thornton Heath Croydon Surrey CR7 7JL 020 8684 1056 020 8689 5885 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Chatrapal Juwaheer Mrs Pauline Rosina Juwaheer Mr Ravindranath Dosieah Care Home 45 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (45), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (45) Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD (of the following age range 55 to 65) and MD(E) The maximum number of service users who can be accommodated is: 45 11th July 2006 2. Date of last inspection Brief Description of the Service: Thornton Lodge is formed of three co-joined, substantial Victorian houses, set amidst the local community of Thornton Heath. The home is situated on the main road close to shops, pub and a local library across the road. The home is easily accessible by public transport, being situated close to bus and rail connections. The home provides care and support for up to 45 older adults with mental health problems. The service provides care for service users who have longterm chronic mental health histories. This includes those who have been diagnosed with functional psychotic conditions (such as schizophrenia, chronic depression and paranoid illness), organic disorders (without major behavioural difficulties), and obsessional or anxiety based disorders. It does not accept emergency admissions or provide an intermediate care service. The registration of the home includes both older persons of 65 years and over, and those aged from 55 to 64. The home provides lounges for both smokers and non-smokers, and a spacious dining area along the back of the house. All bedrooms are single, many of which are ensuite. The home is well-provided for in terms of bathing and shower facilities, and toilets The home was extended in 2007 so as to include a new purpose-built unit providing accommodation for 12 additional residents. The unit includes 12 Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 5 single ensuite bedrooms, an attractively designed lounge and dining areas, a new kitchen, a conservatory, and new office accommodation. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over two days and involved extensive discussion with the home’s registered provider and owner, Mr Chatrapal Juwaheer. The Home’s registered manager was on leave at the time of inspection. The inspector met senior care workers and care staff, and a large number of residents. He inspected the premises, and had wide-ranging discussion regarding the home, examining both service user and staff records. The case records of six recent admissions were case-tracked. These included residents’ referrals, assessments, risk assessments, care plans, medication records and review minutes. Staff records examined included staff rotas, supervision, appraisal and training records. The inspector examined the recruitment records for six new staff recruited since the last inspection, and looked at documentation relating to the day-to-day running and management of the home, including complaints and incidents records. Documentation relating to health and safety including the home’s risk assessments, servicing and maintenance certification, were also examined. The inspector was, once again, impressed with the feel of the home and with the quality of care and support being provided. The home’s provider, Mr Juwaheer, maintains a close day-to-day involvement in the running of the home, and demonstrates a personal commitment to maintaining high standards of operation and ensuring that the home meets the best interests of both residents and staff. The home has been well managed over a long period of time and provides a caring and homely environment for the home’s residents. The home has been recently extended, with a very pleasantly designed, homely and well-planned unit having been created. Feedback from residents and staff was again generally very favourable, with many positive comments being received regarding the home and the support provided. There is substantive evidence of the home providing flexibility and choice for residents in their daily activities and routines, and of respect for residents’ rights, privacy and dignity being observed by management and staff. Overall the inspector finds Thornton Lodge to be a comfortable, relaxed and well managed home. The staff on duty at the time of the inspection presented as supportive and enabling, and were observed to be interacting with residents in a caring, respectful and professional manner. No concerns were raised or identified during the inspection. A potential concern that was identified relates to the staffing level on duty. The inspector noted that the number of staff on duty throughout the day has remained at 5 care staff (including 1 senior care worker in charge) throughout the day, with 3 waking staff on at night (an increase of 1). With the increase in the number of residents from 33 to 38, this level needs to be reviewed. The inspector’s view is that once the home reaches 40 residents, six staff will be Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 7 required throughout the day, and an additional (fourth) night duty staff member (possibly a sleep-in) will need to be added to the rota, if the safety and well-being of residents are to be assured. From this inspection there are a total of 4 requirements and 3 recommendations. The inspector would like to extend his thanks to Mr Juwaheer, to senior care and care staff, and to the home’s residents, for their assistance in helping to facilitate this inspection. What the service does well: Prospective residents are being provided with all the information they require, and the opportunity to visit, before deciding whether the home is likely to meet their needs. Each resident is being provided with a copy of the Home’s terms and conditions at the point of moving into the home. Residents are having their health, personal and social care needs and goals set out in an individual plan of care, and are being involved in the care planning process. Residents are being protected by the home’s medication policy and procedures. Accredited medication training is being provided for all care staff who administer medication. Residents are being treated with respect and their privacy is being maintained. Residents can be assured that, at the time of their death, staff will treat them and their relatives with care, sensitivity and respect. Residents are being provided with a varied range of socially and culturally appropriate recreational and social activities. Residents are being assisted to exercise choice and control in their daily routines, activities and decision-making. Residents are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 8 Residents receive a wholesome, varied and balanced diet in pleasant surroundings. Residents and their relatives can be assured that the home has an appropriate complaints policy and procedure in place, and that their complaints will be listened to, taken seriously and acted upon. Clear information for raising complaints is made available, and residents and their relatives/friends are encouraged to raise any concerns that they may have. The legal rights of residents within the home are being protected and promoted. The home’s policies, procedures and training are helping to ensure that residents are being protected from abuse. While staff at the home are assessed to be meeting the needs presented by the home’s residents, any further increase in their numbers will, if safety is to be assured, necessitate an increase in the staffing level on duty. The home’s residents are being protected by appropriate recruitment policy and procedures, including employment and criminal records checks. Generally, staff are being provided with the necessary induction and training with which to perform their work duties competently, and to safely meet the needs of residents. Residents live in a safe, well-maintained environment, with access to safe and comfortable communal facilities. Residents have sufficient and suitable toilets and washing facilities. Residents’ rooms are safe, comfortable and pleasantly decorated, reflecting residents’ personal identities, and being suited to their individual needs. The home presents as being clean, pleasant and hygienic. All staff at the home receive infection control training. What has improved since the last inspection? All care staff have now completed training in two key areas: Working with service users who present mental health problems; and Working with service users who present challenging behaviour. A development plan, for quality assurance purposes, has been put in place. Health and Safety, and Environmental Health, have completed inspections of the home in 2007. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 9 Two senior care workers have completed Croydon’s ‘Training for Trainers’ course in adult protection. All the home’s policies and procedures have been reviewed (in July 2007). There has been some delegation of the supervision workload, with two senior care workers having received training, and now assisting the manager in supervising staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 to 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are being provided with all the information they require, and the opportunity to visit, before deciding whether the home is likely to meet their needs. Generally, the home is able to demonstrate that the range of needs presented by residents are being properly assessed, and appropriately met. However, a number of care reviews, to assess the suitability of the placement, have not been completed following the initial six to eight week period after admission. Each resident is being provided with a copy of the Home’s terms and conditions at the point of moving into the home. EVIDENCE: Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 12 The home has a Statement of Purpose and Service User Guide. These provide prospective service users with the information they require with which to make an informed choice about the home. Following the planned expansion of the home, both documents have been reviewed and updated. A written service user agreement, outlining the terms and conditions of the placement, is drawn up with each service user who is admitted to the home. This is in addition to the three-way contract agreed between the funding authority, the home and the service user. The service provides care for those who have long-term chronic mental health histories. It does not accept emergency admissions or provide an intermediate care service (standard 6). New residents are only admitted on the basis of a full assessment undertaken by a person who is suitably qualified to do so. Full information, including details of the person’s medical history, and a CPA (Care Programme Approach) assessment and care plan, are obtained following referral by the relevant local authority or agency. The home’s procedure following a referral is for the person being referred to be invited to visit and spend a day at the home, to have lunch and meet with staff and residents. There is initial discussion around the person’s needs and expectations, and information provided regarding the home’s routines and activities, community facilities, and any house rules that apply. A second visit, with an overnight stay, can subsequently be arranged if required. If wishing to proceed with an admission, a date for a pre-assessment, involving the prospective service user and his/her nearest relative or friend/representative, is arranged, and a date set for his/her admission. The admission is then subject to a 28 day trial period, following which a statutory review meeting, is arranged after the first six to eight weeks of the placement. Together with the care coordinator and the person’s key worker, the individual is involved in discussion as to how he/she finds the home, whether the placement is meeting his/her needs, and whether he/she wishes to stay. A decision regarding the suitability of the placement in being able to meet the person’s needs is then made. Following admission, the resident and his/her key worker are involved in drawing up a care plan. This identifies his/her care and support needs, and how these are to be addressed. The care plan is then reviewed on a regular monthly basis. Since the last inspection on 11/07/06 there have been eight new admissions to the home, all of which were referred by health and social services. The inspector completed checks on residents’ files and found that all relevant CPA, Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 13 health and care management assessments had been obtained, and that the home’s pre-admission assessments and risk assessments had been completed. The inspector found, however, that four service user files did not include any evidence of a statutory review having taken place following the admission of the individuals concerned. These reviews must be arranged as soon as possible, with a copy of the review minutes being forwarded to the CSCI; a requirement applies. The inspector spoke with two residents who have been recently admitted. Both residents indicated that they had settled in well and that they were satisfied with the support they were receiving. No concerns or criticisms were expressed. The inspector also spoke with a number of other residents. The views expressed indicated that there was widespread satisfaction with the home, with staff being perceived to be caring and supportive. The inspector observed staff interacting with residents in a caring and enabling way, displaying relevant support and communication skills, and being professional in their approach. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6 to 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are having their health, personal and social care needs and goals set out in an individual plan of care, and are being involved in the care planning process. Residents are being protected by the home’s medication policy and procedures. Accredited medication training is being provided for all care staff who administer medication. Residents are being treated with respect and their privacy is being maintained. Residents can be assured that, at the time of their death, staff will treat them and their relatives with care, sensitivity and respect. EVIDENCE: Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 15 Following the initial assessment, care plans are drawn up by the home, and then reviewed on a monthly basis. The care plan sets out the individual needs of each resident and how the home aims to meet these. Residents are fully involved in the drawing up of their care plans and sign these. Following the initial six-weekly and six-monthly reviews, a statutory annual review is held for each resident, The inspector examined care plans for a number of residents, and found that comprehensive information is being recorded regarding residents’ mental health, physical health, care and support needs, and the actions required to address these. Risk assessments include some covering issues as well as manual handling. Such assessments are carried out by senior staff and are reviewed on a regular basis. The home is moving towards a more person-centred approach in drawing up care plans, involving individuals more fully in this process. Whilst the home has adapted its present care plan format to include ‘the service user’s views’, a new more person-centred format should be developed. A recommendation applies. Service user records indicate that there is regular monitoring of residents’ health care needs, with files including details of visits to/from the GP, the district nurse, hospital and other appointments. The inspector spoke to a number of residents during the inspection. The views expressed indicate that residents feel that their physical and mental health care needs are being well met. The home’s medication policy and procedures were last reviewed in August 2007 and have been evidenced to provide the necessary level of protection for service users. Medication records examined on this and previous inspections have been found to be accurate and well maintained. The home receives medication inspections from an approved pharmacist. This is, however, overdue, the last inspection not having taken place since 8/02/07. A requirement, for an up-to-date inspection, therefore applies. All care staff have previously completed medication training provided by a major pharmacy. Accredited medication training is now being provided by Croydon College, 10 staff having so far completed this training, these staff being listed by the home as being competent to administer medication. This training needs to be extended to all care staff who work at the home; a requirement applies. Residents are able to use their rooms at any time of the day or night. The home has appropriate facilities available for receiving visitors. This includes a small meeting room for any resident who may wish to meet privately with professionals, friends or relatives. A small dining area on the first floor, and Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 16 two conservatories, one in the new annexe, are other suitable areas for this purpose. A public telephone is available in a hooded acoustic location within the main building. Following discussion with the home’s registered provider, the inspector recommends that another phone, for the use of residents, should be installed within the new extension. Consideration could also be given to providing a mobile phone for the use of residents. There have been a number of deaths at the home within the last twelve months. The home aims to ensure that staff are responsive to the needs of the resident and their relatives in the period leading up to, including and following the person’s death, and to provide the necessary care, sensitivity and respect throughout this process. The home recognises that residents may pass away unexpectedly whilst in residence and staff are given all the necessary information through policies and procedures if this occurs. The wishes of the resident, or their nearest relative, regarding the eventuality of the person’s death and the funeral arrangements, are recorded on each person’s file on their admission. The home is not, however, able to specifically cater for the needs of older people who are terminally ill, or those who require nursing or palliative care. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 to 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being provided with a varied range of socially and culturally appropriate recreational and social activities. Residents are being assisted to exercise choice and control in their daily routines, activities and decision-making. Residents are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Residents receive a wholesome, varied and balanced diet in pleasant surroundings. EVIDENCE: Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 18 There are varied opportunities for residents to participate in a range of activities, either within the home, or by going out and accessing facilities in the community. There is a programme of activities, which is publicised on the home’s notice boards. A daily activities hour, between 11 and 12 pm, can include quizzes, bingo, board games, art and drawing, reminiscence and music sessions. The home has made efforts to extend the range of activities on offer and to develop the abilities of staff in facilitating activities. This has included reminiscence sessions with residents. While activities tend to be confined to the daily activity hour, there has been some attempt to provide stimulation at other times. Staff assist in facilitating group discussions and musical sessions. Staff members regularly accompany residents to shops and out for coffee, while student volunteers visit at weekends, engaging residents in conversation, and escorting individual users for a walk in a local park. One volunteer provides some entertainment by playing the piano in the main lounge. The inspector spoke with a number of residents during the inspection. Views expressed indicated that residents have considerable freedom to go out or to participate in activities if they so wish. Staff members regularly accompany individual residents to the shops and out for coffee. Some residents are able to go out with family and friends, and receive visitors. The home has an open door policy in relation to visitors, as long as the resident agrees to the visits. The home has relatively private areas where visitors can be received, and a pleasant garden with garden furniture. Residents are assisted to exercise choice and control over their lives. There are regular monthly residents’ meetings, which cover issues relating to daily activities and routines, and regarding the running of the home. Residents are encouraged to express their individuality by maintaining their previous activities and interests, and by furnishing and using their rooms as their very own. Residents’ rooms reflect individual identities, with residents bringing their own furniture, furnishings, photographs and possessions. Most residents have their finances managed on their behalf by social services or relatives, with residents having the freedom to spend their personal allowances as they wish. Information concerning residents’ access to advocacy services is available if required. Views expressed by residents indicate that they are able to join in with activities if they so wish, or to spend time reading, or pursuing their own interests, including going out to the shops or a café, either on their own or with a staff member. The home organises occasional outings, a recent day trip by minibus to Brighton having proved popular, with 17 residents opting to go, together with 5 staff. Relatives and friends can accompany residents on outings if they so wish. There are also occasional entertainments organised such as at Christmas or Easter. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 19 With the addition of the new annexe, residents now have the choice of two main dining areas in the home. These provide pleasantly arranged areas in which to take meals. There is also a third small dining area on the first floor. The food is prepared in a pleasant new kitchen, situated in the new extension, and the food served presents as being wholesome and nutritious with meat and fresh vegetables being served. Views expressed by residents indicated that they are generally very satisfied with the quality of food being provided, and that good-sized portions are available. Choice is established at coffee time on the morning of the meal. Menus evidenced a varied range of food, and a choice of main dishes each day. The home serves a wide and varied range of meals, which has been extended to include a regular West Indian option. Hot drinks and snacks are available at all times of the day. Residents are weighed regularly and special dietary needs (light diet / diabetic needs) are appropriately responded to. Catering routines are generally good, with records of fridge and freezer being satisfactorily maintained. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 to 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be assured that the home has an appropriate complaints policy and procedure in place, and that their complaints will be listened to, taken seriously and acted upon. Clear information for raising complaints is made available, and residents and their relatives/friends are encouraged to raise any concerns that they may have. The legal rights of residents within the home are being protected and promoted. The home’s policies, procedures and training are helping to ensure that residents are being protected from abuse. EVIDENCE: Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 21 The home has a clear and satisfactory complaints policy and procedure. The complaints procedure sets out the process for managing complaints and ensures they are dealt with promptly and effectively. The procedure states that any complaint will be responded to within twenty-eight days, and that any complaint can be referred to the CSCI, local office at any time during the course of investigation. The complaints book at the home details the outcome of any investigation and what action (if any) was taken. There has been one complaint recorded since the last inspection. Most residents have their finances managed by social services or relatives, though the provider has occasionally acted as an agent/appointee. Records of residents’ personal allowances are maintained. All residents are registered on the electoral roll and assistance is given to enable those who wish to do so, to vote in elections. This includes the use of postal voting. Advocacy services are available to be accessed as and when the need arises. The home has an Adult Protection and Whistle Blowing Policy in place for staff to reference should the need arise. These provide clear guidelines regarding the nature of abuse and the actions to be taken when an incident of abuse occurs or is suspected. The registered provider informed the inspector that all staff have completed their statutory adult protection training with LB (London Borough) Croydon. Two senior care workers have also completed the LB Croydon ‘Training for Trainers’ course in adult protection, meeting a recommendation from the last inspection. This will enable statutory adult protection training to be cascaded to new and existing staff within the home. The inspector spoke to a number of residents during the inspection. This indicated that residents have generally good and trusting relationships with staff, that they feel safe and secure living in the home, and that they would feel able to express their concerns, should any arise. None were identified. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 to 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-maintained environment, with access to safe and comfortable communal facilities. Residents have sufficient and suitable toilets and washing facilities. Residents’ rooms are safe, comfortable and pleasantly decorated, reflecting residents’ personal identities, and being suited to their individual needs. The home presents as being clean, pleasant and hygienic. All staff at the home receive infection control training. EVIDENCE: Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 23 Thornton Lodge has, in 2007, been extended to include a new purpose-built unit. The home now provides accommodation for up to 45 older adults with mental health problems, 12 additional places having been added. There is an ongoing programme of decoration and maintenance at the home. The new purpose-built unit has 12 bedrooms with ensuite facilities, these being attractively decorated and furnished with good quality modern furniture. There is a small reception area with chairs for visitors and a ramp leading up to the front door for wheelchair users. The unit provides a very pleasant and spacious living environment. It includes an attractively designed lounge, complete with widescreen TV and a well-stocked bookcase, a pleasant dining area (with a fish tank), a new kitchen, laundry room, an additional conservatory, and new office accommodation. There are also two bathrooms and two shower rooms, and a small kitchen area (on the 1st floor) for making tea and coffee. This older main part of the home comprises of three co-joined, substantial Victorian houses. This includes 33 of the home’s residents, all in single rooms, the one double room having now been converted into two single rooms. The old office accommodation, on the first floor, has been converted into an ensuite bedroom. Some of the other bedrooms have also been converted to provide ensuite facilities. All bedrooms have a lockable facility. A number of bedrooms were inspected and found to be comfortably and pleasantly furnished, and in a good decorative state. The older part of the home is well provided for with bathing facilities: a Parker Bath, two hoisted baths, and a seated shower adapted for people with disabilities. Toilets are positioned throughout, six being available on each floor of the house. A new toilet and walk-in shower has replaced a small lounge on the ground floor, and a new Parker bath has been installed in the bathroom on the 1st floor. There is a lift for residents to use in accessing the different floors, together with another lift in the new unit. While contrasting with the modernistic look of the new unit, the main part of the home nonetheless provides a pleasant, safe and well-maintained environment for the home’s residents. The older part of the home has two separate lounges, including one for smokers, and a main dining area. There is also a small, quiet room (converted from a small lounge), with tables and chairs, cooking and tea making facilities, on the first floor. There is a pleasant conservatory overlooking a pleasant garden, which residents are encouraged to access. The inspector met a large number of residents who were using the home’s communal lounges. Views expressed were generally favourable regarding the home and the facilities provided. The registered provider advised that residents from both parts of the home are free to use any of the communal facilities, whether in the old or new part of the home. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 24 The home is generally well provided for with regard to measures to minimise cross-infection. Laundry facilities, including a sluice-cycle and disinfection-cycle washing machine, are sited in the basement. Sluice facilities are provided separately from the residents’ toilets, and are regularly maintained to ensure the full sterilisation of commode pans and bottles. Hand washing facilities are prominently sited as necessary around the home. The home was generally found to be clean, hygienic and free from any offensive odours. The inspector understands that all staff are required to undertake infection control training. The home is generally well provided for with regard to measures to minimise cross-infection. Laundry facilities, including a sluice-cycle and disinfection-cycle washing machine, are sited in the basement, together with an additional laundry room and sluice in the new unit. Sluice facilities are provided separately from the residents’ toilets, and are regularly maintained to ensure the full sterilisation of commode pans and bottles. Hand washing facilities are prominently sited as necessary around the home. The home has sufficient heating, all radiators within the home either being low surface temperature radiators or enclosed with appropriate covers. The home is maintained at a comfortable temperature and residents are able to adjust the heating level in their rooms. The home is well ventilated throughout. Lighting throughout the home presents as satisfactory in all areas, and suited to the needs of the service users. Emergency lighting is provided throughout the home and regularly maintained, along with the fire alarm system. All hot water storage tanks and pipe work is maintained with regard to the prevention of Legionella poisoning, through sterilisation and correct temperature maintenance. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 to 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While staff at the home are assessed to be meeting the needs presented by the home’s residents, any further increase in their numbers will, if safety is to be assured, necessitate an increase in the staffing level on duty. The home’s residents are being protected by appropriate recruitment policy and procedures, including employment and criminal records checks. Generally, staff are being provided with the necessary induction and training with which to perform their work duties competently, and to safely meet the needs of residents. EVIDENCE: The expansion of the home to provide an additional 12 places has necessitated a commensurate increase in staffing levels. This takes into account the dependency levels of the current residents, who have both mental and physical health care needs. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 26 With the opening of the new 12-bedded unit, the staffing complement has been increased from 23 to 32 care staff, including 5 senior care staff. The home also employs 2 cooks. An area of concern that was identified relates to the staffing level on duty. The inspector noted that the number of staff on duty throughout the day has remained at 5 care staff (including 1 senior care worker in charge) throughout the day, with 3 waking staff on at night (an increase of 1). With the increase in the number of residents from 33 to 38, this level needs to be reviewed. The inspector’s view is that once the home reaches 40 residents, six staff will be required throughout the day, and an additional (fourth) night duty staff member (possibly a sleep-in) will need to be added to the rota, if the safety and well-being of residents are to be assured. Of 24 care staff, 13 possess a minimum NVQ Level 2 care qualification, and 4 are registered to commence NVQ training from January 2008. The proportion of staff holding an NVQ Level 2 is being maintained at just above the 50 level. to 25 . The home does not currently have any care staff holding an NVQ Level 3. With the expansion of the home, and the loss of a number of staff, there have been a relatively large number of new staff (14) appointed since the last inspection. The inspector completed checks on a sample of six staff files and found that up-to-date CRB (Criminal Records Bureau) and POVA checks had been completed, together with all necessary employment and identity checks. Staff files include a checklist at the front of the file, detailing the recruitment and identity checks required and the date when these have been completed. The home has developed an ongoing programme of training and staff development. Most of the training is completed in-house, although some training has involved external trainers. All staff appointed to the home receive a structured induction programme, based on the Skills For Care standards, with evidence being gathered to support assessment for NVQ level 2. The home has a learning package that covers training in Moving and Handling, First Aid, Health and Safety, Fire Safety and Basic Food Hygiene. The inspector was advised that all staff have now completed training in mental health awareness, and challenging behaviour. There has also been ongoing training of staff in medication, adult protection, moving and Handling, food hygiene, infection control and first aid. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 to 36, and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are living in a home that is being managed competently and in their best interests. The management approach is evidenced to be open and enabling, and conducive to creating a positive and inclusive atmosphere in the home. Generally, the home is able to demonstrate that it is meeting residents’ needs and that it is fulfilling the home’s aims and objectives. A development plan has now been put in place. While residents’ best interests are being protected by the regular and appropriate supervision of staff, annual staff appraisals are also required. The health, safety and welfare of residents and staff are being appropriately promoted and protected. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 28 EVIDENCE: The registered manager, Mr Ravindranath Dosieah, was on leave at the time of this inspection. Mr Dosieah is suitably qualified and experienced to run the home, and has a great deal of management and supervisory experience working with vulnerable people in different settings. He has completed studies leading to the award of NVQ Level 4 and the Registered Managers Award, and has been studying for an A1 and A2 NVQ Assessors award. The inspector had extensive discussion with the registered provider, Mr Chatrapal Juwaheer, and spoke with both staff and residents. There has been a strong personal commitment by Mr Juwaheer to improving the home, with the investment of substantial resources for extending the home and developing good quality services. The home is viewed as being generally well managed, with the home’s provider and manager being well regarded by both residents and staff. The inspector met two recently admitted residents, both of whom felt that they had settled well and had been well supported. Comments cards received from relatives have confirmed that this is a good home, with relatives indicating their satisfaction with the home and the care provided. From the inspector’s observations, and the feedback provided, the management style is one that encourages openness and inclusivity, being both supportive and enabling in its approach. Throughout the course of the inspection staff were observed to interact well with residents and to work together effectively as a team. Residents are, wherever possible, encouraged to participate in the day-to-day operation of the home and to express their views through monthly residents’ meetings, care plan reviews and informal discussions with their key worker or other staff. Staff have the opportunity to express their views in monthly staff meetings, and are consulted within supervision. From the feedback received, the inspector’s impression is that staff feel generally well supported in carrying out their duties The home has quality assurance processes in place. Questionnaires have been developed, with views being canvassed from residents, relatives, professionals and other stakeholders. The home has developed Service User and Staff Satisfaction surveys, together with a Stakeholders Rating Survey. Questionnaires are circulated to residents, relatives and others, to obtain their Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 29 views on a wide range of issues relating to the quality of care, support and services provided in the home. An annual quality assurance review is completed. Since the last inspection, the home has produced a Development Plan. The views of relatives are also obtained through discussion at reviews, and visits to the home, where relatives are able to meet and talk directly with care staff and the manager. Residents’ meetings are held on a regular monthly basis, with minutes of meetings being maintained. Residents are encouraged to be aware of their financial circumstances and are kept informed regarding any proposed changes in fees or outgoings. Most have their finances managed by social services or relatives. The proprietor acts as an agent/appointee for two residents. Records of residents’ personal allowances are appropriately maintained, with both the responsible person and the individual resident signing for each transaction that takes place. All receipts of monies and valuables, held on behalf of residents, are being recorded. The home has a supervision process in place, which covers all the elements of standard 36.3. Supervision is being provided by the registered manager and by two senior care workers, both of whom have attended LB Croydon’s supervision and appraisal training. Staff are receiving supervision on at least a bi-monthly basis. The job description for the two senior care workers does, however, need to be revised so as to include reference to their supervisory responsibilities. Staff are not, however, receiving an appraisal; this should assess their performance, learning and development needs, and should take place on a regular annual basis. A requirement applies. The inspector completed health and safety checks. These were found to be upto-date and satisfactory. Since the last inspection up-to-date Health and Safety (6/3/07), and Environmental Health (2/8/07) inspections have taken place. All services, equipment and facilities are evidenced as being maintained in a safe state to ensure the health and safety of both residents and staff. New staff receive information on health and safety as part of their induction, and foundation training updates are facilitated. The manager ensures that there are safe working practices in the home, which includes moving and handling techniques for the safety of residents and staff. Risk assessments for safe working practices are also carried out. Food and hygiene procedures ensure the safety of staff and residents, and staff attend ‘approved’ infection control training. The home maintains an incidents and accidents record, these being recorded in an appropriate manner. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 30 With the construction of the new extension, updated fire risk and health & safety risk assessments have been completed, together with an emergency plan. Fire safety training is carried out every twelve months by an ‘approved company’ to ensure that all staff are clear of what actions to take should such an event occur. The home has had a recent fire inspection (on 20/9/07), and fire drills are held on a 3 monthly basis. Fire alarms are being tested on a weekly basis. Fire awareness and training is seen as paramount at this home although the inspector suggests that fire training is carried out at least every six months in line with recommendations from the local fire service. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 2 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 2 X 3 Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP5 Regulation 15(2)(b) Requirement Care Reviews Statutory reviews for four recently admitted residents (JB, FK, JR and JD) must be arranged and evidenced. A copy of the minutes of these reviews must be forwarded to the CSCI, Croydon office. 2 OP9 13(2) Medication An up-to-date pharmacist inspection of the home’s medication practice and procedures is required. The last inspection took place on 8/2/07. 3 OP9 13(2) Medication Accredited medication training (provided by Croydon College) must be extended to all care staff who work at the home. 10 care staff, assessed as competent to administer Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 33 Timescale for action 31/12/07 31/12/07 31/03/08 medication, have so far completed this training. 4 OP36 18(2) All care staff must be annually appraised, so as to assess their performance, learning and development needs. 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP10 Good Practice Recommendations The inspector recommends that the home develop ‘personcentred’ care plans in line with PCP guidelines. The inspector recommends that a phone, for the use of residents should be installed in a relatively quiet and private location within the new extension. Consideration should also be given to providing a mobile phone for the use of residents. 3 OP36 The job description, for the two senior care workers who undertake staff supervision, should be revised so as to include reference to their supervisory responsibilities. Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Thornton Lodge (105) DS0000025860.V354576.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!