Inspection on 21/12/09 for Manor Cottage Hotel

This is the latest available inspection report for this service, carried out on 21st December 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Manor Cottage Hotel 07/03/06

Manor Cottage Hotel 09/08/05

Manor Cottage Hotel 16/02/05

Manor Cottage Hotel 05/05/04

Manor Cottage Hotel 23/09/03

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Manor Cottage Hotel 1-3 Manor Crescent Preston Paignton Devon TQ3 2TN     The quality rating for this care home is:   one star adequate 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: Clare Medlock     Date: 2 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 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 35 Information about the care home Name of care home: Address: Manor Cottage Hotel 1-3 Manor Crescent Preston Paignton Devon TQ3 2TN 01803550363 01803526546 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Kenneth Peek Name of registered manager (if applicable) Mrs Sandra Brown Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 18. The registered person may provide the following category of service: Care home only Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: - Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Manor Cottage provides care for up to eighteen people who fall within the category of old age. It is a large, extended detached property situated in a residential area of Paignton. The house is on the level, close to all local amenities. The home benefits from a small level garden. The accommodation is arranged over two floors with some bedrooms on the ground floor. There is a stair lift to assist people to access the upper Care Homes for Older People Page 4 of 35 Over 65 18 0 Brief description of the care home floor, however, it is still necessary for people to manage a few steps at the top of the staircase. Current fees are range between three hundred and twelve pounds and four hundred pounds and avry according to need. The statement of purpose and most recent inspection report are located within the entrance hall. Care Homes for Older People Page 5 of 35 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: one star adequate 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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced and consisted of a visit to the home on Monday, 21st December 2009. We inspected this service with an expert by experience. The Care Quality Commission consider an expert by experience as a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service and spoke with thirteen people and three visitors. This helps us get a picture of what it is like to live in or use the service. During the inspection we spoke with the registered manager, thirteen people who live in the home, three relatives visiting the home, and four staff who work at the home. Care Homes for Older People Page 6 of 35 We case tracked three people who live at the home. Case tracking means we looked in detail at the care these people received. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us or able to provide feedback. We looked at staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means the people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Manor Cottage Hotel. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? Since the last inspection, there has been a change of manager. The manager has passed the Care Quality Commissions fit person process which is used to decide whether a person has the skills and knowledge to manage a care home. There have been many environmental changes in the home since the last inspection. New carpet has been fitted throughout the majority of communal areas of the home. The kitchen floor has been replaced, and kitchen staff have been provided with new fridges and dishwashers. The cooker has also been overhauled. The dining area has been redecorated and refurbished and a water cooler introduced so people have access to drinking water at all times. People are now aware that fresh fruit is available at all times of the day. A new wet room has been introduced to enable people to enjoy a shower whilst maintaining their safety. Care Homes for Older People Page 8 of 35 What they could do better: Since the departure of the previous manager in June 2008, many policies and documents had not been updated to reflect the changes. These changes include information on the new manager who has been in place since November 2008, information regarding staff and their qualifications and information about the changes in contact details for the Care Quality Commission. The statement of purpose, contract, service user guide, complaints policy, whistleblowing policy must all be updated with the changes. This will ensure that people have accurate and up-to-date information regarding the home. The management of medications must also be improved. Minor improvements, such as ensuring two staff sign when hand written entries are entered onto the medication administration record, would reduce the risk of errors. More serious issues, such as allegations of staff administering medications in a way that may increase the risk of errors being made, must be monitored and addressed where necessary. Staff should also ensure that any creams and lotions used on people are labelled with the persons name and date of opening, to ensure that they are used for that person only, and used within timescales to reduce the spread of infection. Care plans should be improved at the home to reflect and evidence the care that is actually provided. Where personal care is offered, provided or declined, records should be maintained to show that plans of care are implemented and evaluated. Systems should also be in place to ensure that care plans are reviewed each month. Improvements within the environment should also continue, to improve the standard and quality of the environment in which people live, but also improve safety for staff and people in the home. Loose tiles within bathrooms and toilets should be removed to reduce the risk of injury. Cracked sinks should be replaced to reduce the spread of infection. Worn furniture which causes a risk of infection should also be removed and replaced. Systems should also be introduced to improve the standard of hygiene within the home. Consultation from staff at the health protection agency would highlight any changes that were needed within the home to improve hygiene and reduce the spread of infection. This should include suggestions regarding storage of clean linen. Cleaning rotas should be reviewed to ensure that toilets are free from stains and fecal debris. Cleaning schedules would also ensure that carpets are cleaned on a regular basis to remove debris and dust. The manager must also ensure systems are in place to ensure temporary heating does not cause an additional risk to people in the home. Although people are pleased with the care they receive at the home, this could be improved by reminding staff to ensure that all people in the home have access to a call bell for their safety. Staff should also be reminded that when they take hot drinks and food to people to ensure those people are able to reach their hot drink and food without causing them risk. The manager should also review how complaints are managed in the home. Any Care Homes for Older People Page 9 of 35 concerns, complaints or allegations must be recorded. This will ensure that any trends in issues are highlighted and would also show that the complaints process is transparent, robust and effective. The manager should ensure that all people in the home know that they are able to raise any concerns without fear of reprisals, by providing reassurance. Recruitment at the home must be improved as a matter of priority. References must be from suitable sources and not written by people already working within the care home. Previous employers should be asked for a reference. Criminal Records Bureau checks must be performed on new staff, or clear risk assessment must be in place to explain why this is not done. Recruitment checks must include evidence that the proof of identity has been maintained on staff file and also include a recent photograph. The manager should introduce quality assurance systems which will pick up any shortfalls or areas of care that is needed improvement. Quality assurance systems should include ways of monitoring policies and documents such as information provided to people, recruitment, medication practices, care practices, environmental checks and care planning. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 35 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 11 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the pre-admission assessment is satisfactory, information provided to people is out of date and does not provide people with the information they need to decide whether the home can meet their needs. Evidence: The manager explained that following an enquiry, she visits the person to perform the pre-assessment, meet the person and discuss fees if relevant. The manager explained that she considered it important to ensure that she considered the person would fit in with other people at the care home. The manager explained that the pre-admission assessment is performed. This document was seen within the care plan and contained necessary information to decide whether a home can meet the persons needs. The AQAA (Annual Quality Assurance Assessment) states that staff gather as much information as possible about individuals from professionals and other and people. The pre-admission assessment means individuals have their point of view about what they Care Homes for Older People Page 12 of 35 Evidence: feel they need to support when entering a caring environment. We give empathy to individuals as to how they may be feeling about coming into a caring environment and give them time and involvement. The home have a statement of purpose and service user guide which are located within the entrance hall of the home. The statement of purpose was out of date and needed updating. The document contains details of the old manager who had left the home two years ago. The statement of purpose also contained out of date contact details for the Care Quality Commission and information on staff that was not up to date. An example contract was also located within the entrance hall which also needed updating to contain details of the Care Quality Commission. The service user guide was also located within the entrance hall of the home. This information contained views of people living in the home in 2005, out of date information about the qualifications of staff, and out of date contact details of the Care Quality Commission. Care Homes for Older People Page 13 of 35 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. Although generally people have their health care care needs met, improvements to records and care plans would show how specific care needs can be met. Medication systems are generally good, but improvements and monitoring would reduce errors being made and prevent the spread of infection. Evidence: The people we spoke with were generally very happy with the care provided at Manor Cottage Hotel. One person said Ive been here for years and the girls are very kind. Ive heard lots of tales of woe in other homes, but I am very lucky here. They are very good, getting what I need. Staff interactions with people at the home were all positive on the day of inspection. Staff acknowledge people and their needs with one member of staff even suspending her coffee break to meet the needs of the person requesting assistance. Terms of affection and endearment were seen and heard throughout the inspection and some people enjoyed friendly banter with the staff. Care Homes for Older People Page 14 of 35 Evidence: People we saw appeared well cared for with finer details of care given, including hearing aids and glasses in place and appropriate footwear present. Ladies had their hair styled an attractive way and the men were cleanly shaven. People being cared for in bed looked warm, pain-free and comfortable. With the exception of one person, people had access to call bells and a drink. This person did not have access to a call bell which had been wrapped around a picture on the wall which would even be difficult to access if the person was lying in bed next to the wall. Staff were seen and heard to knock on bedrooms doors and wait before entering. No evidence was seen of personal care being given with bedroom doors open. Each person has a set of care plans which contained personal information, preadmission information and daily living assessments. Care plans also contained information regarding specific wishes regarding funeral arrangements and end of life care. Care plans were generally well written and clear to follow and had been subject to monthly reviews. However, there was no monthly review for November or December and where people require specific care, records were not present to show that this care had been provided. One example being a frail person being cared for in bed who was not eating or drinking regularly. Discussion with care staff indicated that this information was communicated verbally between staff, and staff were aware of each persons needs. When speaking with the person they confirmed that staff were very attentive ensuring food and drink was given whenever they woke. Discussion was held regarding the importance of maintaining accurate daily reports and using care charts to evidence that care had been provided. Visiting health care professionals described the home as lovely saying that staff at the home call district nurses appropriately and maintain a good relationship, carrying out instructions effectively. The health care professional said that people say they are happy and have no complaints and that there are never malodours present at the home. Care records showed that people have access to NHS services both in and out of the home. Health care professional involvement included dentists, general practitioners, opticians, outpatient appointments at hospitals, respiratory nurses, and district nurses. Weight charts are maintained on people to monitor weight loss and weight gain. There were no care plans to show what care was planned when a weight loss was noted but charts showed that weight increased following unexplained loss. Care Homes for Older People Page 15 of 35 Evidence: Medication systems were generally well managed. Medication administration records were well completed and contained information regarding omissions of medication. Systems were in place for a safe receipt, storage and return of medications. Staff informed us that senior carers were responsible for the medication systems and had additional training. We were informed that the supplying pharmacy (Boots) performed audits to ensure the systems were robust. Homely remedy policies were in place and photographs on the medication administration record (MAR) sheet were present. It was noted that hand written entries on the MAR sheet were not always witnessed by two members of staff which is suggested to reduce the risk of errors being made. A tour of the building took place where it was noted that creams and lotions were availiable for use on people in the home. These had not been dated and were not marked with the name of the person they related to, despite some being stored in communal areas. Discussion was held regarding the importance of marking the date of opening and ensuring the product was labelled to ensure the cream was for one person only, and to reduce the spread of infection. During the inspection we were informed that some medication administration practices had been questioned. We had received information that some staff may be potting up medications before they are administered. This was not witnessed at the inspection but is considered bad practice and must be monitored and stopped. Despite staff all attending moving and handling training, we witnessed a person becoming ill at lunchtime. Whilst being transferred to a wheelchair the brakes had not been applied, causing staff to strain to support the weight of the person. The foot rests were used correctly. Care Homes for Older People Page 16 of 35 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 have choice and control over the majority of their lives and have access to an activities programme. People also have access to a varied and wholesome diet, although improvements to some aspects of care, would improve safety and quality of life at mealtimes. Evidence: People appeared to have a choice of when they went to bed and got up in the morning. At 1030am several people were still in bed having chosen to either stay or return there following breakfast. One person told us they let me lay in bed whenever I want to, some days I wake up and just want to stay here all day. Another person told us she was very happy at the home saying I have got a phone and can speak to my goddaughter niece at any time and I am at the front of the house so I could see the comings and goings. I enjoy the food and get it whenever I wake up, and have been very blessed living here. Most people appeared to be content with quite a few sleeping or dozing in comfortable looking armchairs in the morning although a couple repeatedly asked to be taken Care Homes for Older People Page 17 of 35 Evidence: outside for a cigarette and staff advised they would have to wait until just before lunchtime at which point they were taken outside. Provision is available for those wishing to smoke to proceed through the kitchen and across an open yard to a storehouse where they may smoke. People who wish to walk around the home appear to have the freedom to do so. People receive their post unopened and were helped to read cards and letters if requested. The manager told us she organises the activities, which are then delivered by senior carers. There is no named or dedicated activities organiser. Events include bingo, quizzes, chair exercises and table games. Visits are received from singers, entertainers, a guitarist and a local donkey sanctuary. Photographs were displayed showing the most recent donkey visit. Equipment within the lounge area included reading books, bingo equipment, jigsaws and puzzles, games such as skittles, and arts and craft equipment. People could not recall any trips out but the manager advised that five months previously (in July 2009) she and her daughter had taken two carloads of people to Dartmouth. There had been no trips out prior to that one. A newsletter with December activities was provided for people living in the home. Activities in December included a Christmas party, Christmas bingo, mince pie and Sherry afternoon, Christmas quiz and cheese and wine party for relatives. Christmas music was being played on the day of inspection, and prompted some people to join in with the carols. In the afternoon the activity was card making, which appeared to be enjoyed by many people. Some people had their walking aids decorated with tinsel and Christmas decorations. The home was decorated with Christmas decorations including several trees and festive table coverings. We were told that a Catholic priest visits weekly and a Church of England vicar fortnightly when people can receive Holy Sacrament. We were told that about a dozen people take advantage of these occasions. Some people chose to eat some or all of their meals in the bedroom instead of in the pleasant dining room. We were informed that people in the home have access to Sherry and wine to accompany their meals at times. Lunch at 12.30pm is a choice from two set items with alternatives available. Opinions about the food included, Food very good, Not bad, I enjoy the food, I like the Care Homes for Older People Page 18 of 35 Evidence: dinners, Nothing wrong with the food, Im happy with the food, and We have good food. No one could recall being asked what their favourite meal would be but several added that they were easy when it comes to food. It was noted during the inspection that staff did not always consider whether it was easy for a person to reach their meal without risk of accidents or promoting independence of the person. Simple considerations such as propping a person forward in the chair using a pillow and using a more appropriate tables to bring a meal closer to the person had not been addressed. One person therefore, had to lift a bowl of hot soup onto their lap and balance whilst eating. Another person was given a hot drink which was located within reach but needing a stretch which has the potential to cause an accident. The home have a drinking water dispenser in the entrance to a lounge but this was without any water. The manager confirmed that they had run out of water canisters and were awaiting a delivery. A bowl of fresh fruit was available for people to help themselves at any time during the day. People were seen and heard to request refreshments at any time during the day and staff were receptive and responsive to this need. Care Homes for Older People Page 19 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the way complaints are managed and handled would mean that people are more empowered to raise issues confidently. Evidence: The home has a complaints procedure which is displayed within the entrance hall and the statement of purpose. Both documents were out of date and did not contain the up-to-date contact details for the Care Quality Commission. The home also have a whistleblowing policy which was also out of date and did not contain the up-to-date contact details for the Care Quality Commission. The manager explained that she had not had any complaints since her arrival at the home. However discussion with relatives confirmed that they had raised concerns with the manager who had not handled complaints to their satisfaction. This issue was discussed at the time of inspection with both the relatives and manager concerned. An action plan was agreed to ensure the person in the home was having their care needs met. This information was also communicated to the persons care manager for review in a few weeks time. Discussion was carried out with the manager about the management and handling of complaints with suggestions on how complaints can be managed and recorded to show the process is robust, effective and pro active. The manager confirmed that there is not a complaints register at present, which would enable the manager to monitor any Care Homes for Older People Page 20 of 35 Evidence: trends in concerns or complaints. The manager gave assurances that this would be introduced. Without exception everyone responded that they felt safe living at the home. One person added, I feel as safe as an old person can be. The majority of people said that the staff listened to them and would deal with any concerns, although one person raised some concerns and said I do not like upsetting the staff as they only take it out on you. No one admitted to making any complaints or raising any issues. The AQAA stated there is an empowering of service users to complain if they need to do so and any issues. The issues are addressed straight away by the manager. Service users are made aware of the complaints procedure is as well that staff. Staff are aware of a whistleblowing policy Care Homes for Older People Page 21 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the environment is comfortable and homely, and there has been considerable investment and improvements in equiment and furnishings, several areas of the home require attention, by either a change in practice, or repair, to reduce risk to safety. Evidence: Some areas of the home were well maintained. Since the last inspection a new carpet has been fitted throughout the majority of the home. However the existing carpet awaiting renewal had been taped in places where areas of the carpets were worn and torn. The kitchen floor has been replaced and new fridges and a dishwasher has been provided. The cooker has been overhauled as has the dining area. A new wet room has been introduced to enable people to have a shower in a safe environment. Other people have access to ensuite facilities and domestic style baths, which staff assist people to access safely. All radiators are now guarded, although a portable radiator was found in one room which was not guarded and was very hot to touch . The person in this room said The radiator has never worked since I arrived here over a year ago. The manager disputed this saying the radiator did work and probably just needed bleeding. Care Homes for Older People Page 22 of 35 Evidence: Other areas of the home were in need of repair. Some sink surrounds were worn which causes a risk of the spread of infection. One sink was cracked which also causes a risk of the spread of infection, and some tiles in the staff bathroom were loose and at risk of falling off causing injury. The home had received a letter from the fire department saying that they were not meeting requirements expected in care homes. One of these requirements was lack of access in a fire exit. A tour of the building confirmed that this fire exit was now clear from obstructions. The AQAA stated We are planning a conservatory, so service users have more natural light and a space to entertain visitors within. We also plan to have raised planters in the patio area for those service users that like gardening and wheelchair access from the conservatory entrance. People we spoke with said they were not aware that staff usually wore gloves and aprons, although staff are wearing gloves and aprons on the day of inspection. Hand gels were available throughout the home. However, equipment required for the prevention of spread of infection was not located in all areas of the home. In one communal bathroom there was a communal towel, which is seen as poor practice where people are living communally. Laundry facilities were located outside of the home. No other alternative means staff have to carry dirty clothes and linen to the laundry whilst walking through the kitchen area. The manager explained that foul linen is carried within sealed plastic bags to reduce the spread of infection. Following the fire authority visit, clean laundry had also been stored within a cupboard inside a staff toilet. Discussions were held regarding the risk of spread of infection with this. Discussions were held regarding the benefit of inviting the health protection agency in for advice and guidance on how staff can reduce the spread of infection in the home. The majority of toilets were clean. However some toilets that had raiser seats or frames surrounding them were not clean and contained stains and spots of dried faeces. Care Homes for Older People Page 23 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The popular staff group have access to a wide range of training. However improvements are necessary to the recruitment process to show that staff have had all the checks necessary to show they are appropriate to work with vulnerable people. Evidence: People were generally very complimentary about the staff. Comments included The staff are all very nice and listen to you if you have any ideas and The girls are great and work hard all the time. The consensus of opinion was that there were just about enough staff. People said, They have to work very hard, and Staff are very nice but they dont have much time to talk, they are busy all the time. Several people said they never used the call bell but others said the response time was generally within five minutes and, The staff are never grumpy when they come. A member of staff who joined the staff group a year ago said that they had been on many courses, had attained NVQ3 level and was currently working towards the next level. Whilst the studying is undertaken in their own time the fees were paid by the home. The learning had proved very useful both at work and in the private life of this person. Care Homes for Older People Page 24 of 35 Evidence: We were told that all staff had either achieved NVQ training or were on courses to achieve this. Many staff had achieved more than an NVQ two level. We were also informed that some staff were on special training courses to enable them to train staff in house. Other staff had IT certificates and assessors in care awards- which enable them to assess staff who are training on NVQ courses. The home have been recognised as being pro-active in achieving staff training. The manager accesses training through Torbay Care Trust and was in the process of booking refresher courses and new training. All staff files contained evidence that staff had completed a formal induction programme and had access to staff supervision. Staff files did not show that the recruitment process at the home was robust and did not match what was stated in the AQAA. The AQAA read CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable adults) checks are carried out on staff before being employed and three written references are taken from other employers. However, None of the three files inspected supported this statement. None contained all the information necessary to show that staff have had the checks necessary to show that they are safe and appropriate to work with vulnerable people. One staff file did not contain a Criminal Records Bureau check (CRB) or a protection of vulnerable adults (POVA) check performed by the manager or provider. The person also had two written references provided by the manager working at this home and a senior carer working at this home. Previous employer references had not been requested. References for other staff and CRB and POVA checks were suitable. None of the staff files contained an up-to-date photograph and one file did not contain evidence that proof of identity had been retained, although this had been checked for purposes for the CRB check. Care Homes for Older People Page 25 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the home provides clear and practical leadership to staff, however, the lack of attention to following some legal processes and the slowness in updating important procedures and practices lets the service down. Evidence: Staff spoken highly of the manager at the home and said communication between staff is very good. We were informed that the manager has several members of her family working at the care home. We were not informed of any concerns regarding this. The manager has vast experience of working and managing care homes. She has an advanced management in care qualification, and NVQ four in care and the registered managers award. The manager explained that she had a good working relationship with the provider and was supported when making managerial decisions. Staff told us that they were able to express their views with the manager and felt that Care Homes for Older People Page 26 of 35 Evidence: the staff team worked well together. The manager explained that no personal monies were held for people in the home, and that this was done either through families or the person themselves. Valid insurance certificates were displayed to show the home had suitable insurance cover until November 2010. Many policies displayed within the home were out of date and need of review and update. Many had not been updated since the departure of the previous manager in June 2008. Many policies contained incorrect information regarding the manager, staff and contact details of the Care Quality Commission. The manager explained she was in receipt of generic care home policies which she was in the process of reading through to ensure they were accurate and relevant for Manor cottage hotel. Training was seen as a high priority in the home. The manager accesses both mandatory and specialist training via the local care trust. Funding is also accessed for NVQ training. Staff appreciated the training and confirmed that training was provided and funded. The manager explained that she was present on a daily basis at the home and was able to address any issues as they arose. However, there were no clear audit processes in place to highlight out of date policies, information and practices such as statement of purpose, complaint process, medication process and staff recruitment. It was easy to locate questionnaires from 2005 but not from 2008 or 2009. Eventually two questionnaires were located from 2008. The AQAA read We are open to change when needed to move the home forward reviewing, monitoring and feedback from staff, service users and outside organisations. Care Homes for Older People Page 27 of 35 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 28 of 35 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 1 1 5 The service user guide must 11/03/2010 be updated to reflect the service is provided at the home. This must include upto-date views of people in the home, qualifications of staff and the Care Quality Commissions contact details. This will mean that people have the information they need to decide whether the home can meet their needs. 2 1 4 The statement of purpose must be updated to reflect the services provided at the home. This must include details of the current manager, the Care Quality Commission contact details and information regarding staff working at the home. 11/03/2010 Care Homes for Older People Page 29 of 35 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 This will mean that people have the information they need to decide whether the home can meet their needs. 3 1 6 The manager must update the statement of purpose and service user guide and inform the Care Quality Commission within 28 days. This will enable the manager to inform us of changes in the documents 4 7 15 Systems must be in place to 11/03/2010 ensure that service user plans are kept under review. This will show that the care needs of people are continually kept under review. 5 7 15 Systems must be in place to ensure that evidence is provided regarding the evaluation of care needs. This will show that general and specific care needs are identified and met. 6 8 13 Systems must be in place to ensure that all people have access to a call bell at all times. This will ensure people are safe at all times 22/01/2010 11/03/2010 22/01/2010 Care Homes for Older People Page 30 of 35 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 7 9 13 Systems must be in place to 11/03/2010 ensure that safe administration of medication practices are adhered to, monitored and corrected as necessary. Staff must be informed that potting up is not appropriate and and unsafe. This will minimise any risk to people at the home. 8 16 17 The manager must establish a system to record complaints. This will show that complaints, concerns and allegations are managed effectively within timescales and will also identify any trends that may occur. 11/03/2010 9 25 13 Systems must be in place to ensure temporary heaters are safe and do not cause risk of burns or scalds. This will reduce the risk of burn and scalds and prevent people from unnecessary risk. 11/03/2010 10 29 19 Written references must be from suitable sources including previous employers. This will show that staff 11/03/2010 Care Homes for Older People Page 31 of 35 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 have had suitable checks to show that they are appropriate to work with vulnerable people. 11 29 19 Staff at the home should not 11/03/2010 be employed until full and satisfactory information is obtained off them. This must include two written references from suitable sources including previous employer, proof of identity including a recent photograph, Criminal Records Bureau and Protection Of Vulnerable Adults (POVA) check (now ISA check) performed by the employer. This will show that staff have had suitable checks to show that they are appropriate to work with vulnerable people. 12 33 24 Ensure quality assurance systems are in place to review and improve the quality of care provided at the home. This will show that the registered person continually ensures the service meets the needs of people in the home. 11/03/2010 Care Homes for Older People Page 32 of 35 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 2 2 7 The contract should be updated to include up-to-date contact details of the Care Quality Commission. Records should be maintained, as per the action plan to ensure that evidence is provided that call bells are within reach for all people in the home. Staff should ensure that any moving and handling techniques are in line with current good practice. Creams used for people at the home should be labeled with their name and marked with the date of opening to reduce the spread of infection Hand written entries on the MAR sheet should be witnessed by two people to reduce the risk of errors being made. Staff should be reminded to ensure that when people are given drinks and meals that additional care is necessary to ensure they have easy access to hot food and drink without placing the person at risk. The complaint policy should be changed to include up-todate contact details of the Care Quality Commission. Systems should be in place to reassure people that their feedback, complaints and concerns are valued and they will not be affected if they raise such issues. The whistle blowing policy should be changed to include upto-date contact details of Care Quality Commission. Worn furniture and sink surrounds should be replaced where they cause a risk of the spread of infection Loose tiles should be removed from the staff bathroom to prevent risk of injury The identified cracked sinks should be replaced where they cause a risk of the spread of infection Systems must be in place to ensure the taped area of carpet is safe whilst waiting for renewal. Systems must be in place to ensure that toilets are hygienic and clean. Systems must be in place to ensure the carpet in the identified bedroom is cleaned and free from debris on a regular basis. 3 4 8 9 5 6 9 15 7 8 16 16 9 10 11 12 13 14 15 18 19 19 19 19 26 26 Care Homes for Older People Page 33 of 35 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 16 26 The manager should consider inviting be health protection agency to visit the home to provide advice and guidance on how the home can reduce the spread of infection The provider should be able to provide documentary evidence to show that they have risk assessed the necessity of getting a new CRB. Updating of policies should continue at the home 17 29 18 36 Care Homes for Older People Page 34 of 35 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. 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. 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