Inspection on 24/06/08 for Manor Lodge

This is the latest available inspection report for this service, carried out on 24th June 2008.

CSCI found this care home to be providing an Good service.

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

Other inspections for this house

Manor Lodge 25/04/06

Manor Lodge 06/09/05

Manor Lodge 04/04/05

Manor Lodge 17/08/04

Manor Lodge 14/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Manor Lodge 32/34 Manor Road Harrow Middlesex HA1 2PD Lead Inspector Julie Schofield Key Unannounced Inspection 24th June 2008 08:25 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 Manor Lodge DS0000017549.V364439.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. Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor Lodge Address 32/34 Manor Road Harrow Middlesex HA1 2PD 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) 020 8427 3211 020 8868 8375 rmd@ukgateway.net R.M.D Enterprises Limited Mrs Laura Silvia Fernandes Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies 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: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 16 22nd August 2007 Date of last inspection Brief Description of the Service: Manor Lodge is a care home providing personal care and accommodation for 16 older people. It is owned by R.M.D Enterprises. At the time of the inspection 14 residents were living in the home. The home is located in a quiet residential road, within a few minutes walk from Kenton and central Harrow, where there are numerous shops, restaurants, cafes, banks, and other amenities, which include public transport facilities. The home was opened in 1990. It is a detached building with parking for several vehicles at the front of the home. The home has 14 single bedrooms, 4 of which have en-suite facilities. There is one shared bedroom. The care home has a passenger lift. There is an enclosed well-maintained garden at the rear of the property, which is easily accessible. Information about the service provided by the care home is available to people living in the care home and is available from the provider. During the inspection information was given about the fees charged for the service. For accommodation in a shared room the fees range from £390-£425 per week and for accommodation a single room the fees range from £475-£500 per week. The level of fees is according to an assessment of the individual needs of the resident. Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is a 2 star. This means the people who use this service experience good quality outcomes. The inspection took place on a Tuesday in June, starting at 8.25am and finishing at 6.15pm. During the inspection we spoke with the manager, one of the providers and with members of staff. We also spoke with some of the residents and with relatives visiting the home. We examined records and the care of a number of residents was case tracked. A tour of the building took place and the serving of a meal was seen. We checked compliance with the statutory requirements identified during the previous key inspection in August 2007. Survey forms were sent to residents and at the time of writing the report 9 of these had been returned. We have also received 11 survey forms from relatives, 5 survey forms from members of staff and 1 survey form from a health care professional. A relative of a resident that has recently passed away wrote to us. We would like to thank everyone for their assistance and for their comments during the inspection process. The service returned an Annual Quality Assurance Assessment (AQAA) and we have also used this in the inspection. What the service does well: Residents were positive about the service provided in the home and said “they are the tops” and “the girls are lovely, I’ve never heard a wrong word”. One resident said about the staff, “their life is around us. We come first, whoever is on duty”. The manager was praised and one resident said, “Laura is good at the helm”. Residents were appreciative of the attention to detail and a resident that enjoys reading said that the proprietor noticed that she was reading a Reader’s Digest magazine and now the resident gets a regular supply. Residents said that they liked living in the home and that they were happy at Manor Lodge. When a resident moves into the home it can be a difficult time for their relatives but relatives said that the manager and proprietor were aware of their Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 6 feelings and supported them through the process. Relatives spoke of visiting the home and how it “felt right” and that they saw happy looking people living in the home. Contact with the families is good and a relative said that they trusted the home to care for the resident. One relative said that their resident never stops telling me, “we made a good choice here”. Relatives agreed that the members of staff are friendly, polite and caring. Members of staff said that Manor Lodge “provides a high standard of personal care”, “good training for staff”, “a homely environment for the residents” and is well managed. What has improved since the last inspection? What they could do better: Care plans need to be reviewed on a regular basis so that changes in the needs of residents can be identified quickly and addressed. Manual handling risk assessments need to be more detailed so that safety is maintained during the process of transfers. A programme of redecoration/refurbishment has already begun in the home and the areas identified during the site visit in respect of redecoration, repair and replacement need to be incorporated into the programme so that residents enjoy a well-maintained environment. A washing machine with a sluicing cycle is needed so that the home can support residents with continence problems. Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 7 It is important that the hours of the manager are appropriately used and not all of her existing hours are supernumerary on the rota. When the cook is on annual leave a replacement cook must be employed rather than the manager covering these duties. Due to members of staff leaving the home the percentage of staff members within the team with an NVQ qualification has fallen. Members of staff without this qualification need to enrol on a training course so that qualified members of staff support residents. The validity of references must be maintained to ensure that the safety and welfare of residents is not compromised. Therefore it is inappropriate for a family member to supply a person with a reference. The home must be able to demonstrate that health and safety is promoted. Copies of all documents relating to servicing of or remedial work to equipment or systems in the home must be available. 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. Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 8 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 Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Carrying out an assessment of the resident, prior to admission, ensures that the needs of the resident are identified and that the home is able to determine whether these can be met. Visiting the home prior to admission assures the resident that this is somewhere they would like to live. Standard 6 was not inspected, as the care home does not provide an intermediate care service. EVIDENCE: Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 10 The manager has drawn up a new assessment form for use. This is more detailed and comprehensive. We looked at the files of 2 residents that have recently been admitted to the home. There is evidence that the manager and proprietor visit the prospective resident as part of the pre-admission process and that an assessment of need is carried out. The assessment is then used as a basis for developing the care plan. We discussed the information given to the home by the funding authority as part of the pre-admission process and recommend that if a referral is made by telephone the home requests that this is confirmed in writing. We spoke with relatives about the pre-admission procedure. They confirmed that a thorough assessment of need was carried out by the home before a placement was agreed. A relative said that the manager and proprietor visited the resident while they were still in hospital. Another relative said that the proprietor had spent an hour with them when the relative visited the home and that half of the time was spent in finding out about the resident and what they liked and disliked. One relative commented, “From the outset I was given very clear and helpful information”. One resident that had lived in the home for a few months said that she had not needed to visit the home prior to her admission because she used to visit a neighbour of hers that lived in the home previously so she knew what it would be like. Another resident said that before living in the home she had visited a few care homes before making her choice. We asked why she chose Manor Lodge and she said that it had quite impressed her and that it meant she could keep her own GP. Relatives confirmed that they had visited the home as part of the assessment process and one said that the home had “a lovely warmth and there was a contented atmosphere” in the home. Another relative said that they were immediately struck by the warm welcome that they received. Visits to the home had provided an opportunity to view the premises and to meet the manager and her staff team. Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Comprehensive care plans assure residents that their individual needs are understood. However, regular reviews and detailed evaluations of the care plans would assure residents that changes in their needs are identified and addressed. More detailed manual handling risk assessments would assure residents that arrangements for helping them with transfers promote their safety. The health and well being of residents is promoted through regular health care checks and appointments. Residents are supported in taking their medication, as prescribed by their GP, in order to maintain their general health. Discreet and caring support is given to residents by staff so that the privacy and dignity of the resident is respected. EVIDENCE: Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 12 Since the previous key inspection the format of the care plans has been revised so that they are more person centred and we saw all of the newly completed plans. The plan identified a need and then detailed the abilities of or the help required by the resident. The assistance from members of staff to promote independence was described. The needs identified included physical care, health care and social care needs. Where possible, the plans had been signed by both the manager and the resident and were dated. When residents were asked on the survey form whether they received the care and support they needed 7 residents ticked “always” and 2 residents ticked “usually”. When relatives were asked whether the home gave the support or care to the resident that the relative expected or agreed, 9 relatives ticked “always” and 2 relatives ticked “usually”. Although the home evaluates the care plans on a monthly basis, and these were up to date, a formal review on a regular basis i.e. every 6 months and where the funding authority is invited to attend does not take place. Evaluations were brief and often consisted of “no changes” and it is recommended that these give more detail so that they are informative. When members of staff were asked on the survey form whether they are given up to date information about the needs of the people that they cared for e.g. in the care plan they agreed that they are. Care plans include risk assessments for falling, mobility and for manual handling. The manager said that 5 residents have risk assessments for pressure sores. There was evidence that the risk assessments are reviewed on a regular basis and that the reviews were up to date. However, we noticed that the risk assessments for manual handling lacked details regarding the intervention required and the equipment needed. We saw that case files contained evidence of access to health care resources in the community. The District Nurse visits the home when asked to do so by the GP. There are regular appointments with the chiropodist and optician but the dentist that has supported the home has now retired. Residents were able to have a flu jab, if they wished. Support was given to residents for outpatient appointments at the hospital, if a relative was not able to accompany them. Residents had routine health screening e.g. blood tests, as necessary. We discussed pressure care. The guidelines for pressure relief were reviewed in May 2007. The manager said that none of the residents have a pressure sore. If necessary, pressure-relieving equipment is arranged for residents by referral to the GP and then after an assessment by the District Nurse. A relative said that their resident had a leg ulcer when the resident was admitted to the home and that it had now healed up. The staff had been vigilant in calling the District Nurse, they had taken him to hospital for an appointment at the vein clinic and they had massaged and rubbed in ointment. The manager Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 13 said that all residents are able to mobilise and that they are encouraged to walk to the toilet and to have walks in the garden or to go out for a walk so that they keep active. A relative told us that the mobility of their resident had improved since living in the home. The proprietor confirmed that there is always at least 1 member of staff on duty that is a qualified first aider. A relative said that their resident “had never looked so well for a long time” and credited the home for this. The home has a storage and administration of medication policy and we saw that it had been reviewed in March 2007. There were also guidelines in respect of homely remedies and for safe swallowing. There were policies for the self-administration of medication and for the covert administration of medication. Members of staff that administer medication have received training and a record of this is kept on file. The storage of medication in the home was safe and secure. Records of the administration to residents were up to date and complete. The home uses a system of weekly dossette boxes and the pharmacist fills these. The tablets already removed from the boxes corresponded with the day of the week and the time of day that the inspection took place. The home has a written policy on maintaining the privacy and dignity of the resident and the policy was reviewed in September 2007. We were told by a member of staff that when assisting a resident with personal care it was important to close doors to maintain privacy, to speak with the resident and to explain what they wanted to do and to talk to residents nicely and to reassure them. A relative said that their resident had their hair styled on a regular basis, she had nail polish applied, her clothes were clean and she had gained in confidence. Another relative said that their resident certainly appreciated having her hair done and nails manicured. We spoke with 2 residents about privacy and dignity within the home and they both agreed that these were maintained. One resident said of members of staff, “they are respectful and I can find no fault”. Both residents agreed that when they needed to see the GP the consultation took place in their own bedroom. They said that if they were in their room and a member of staff wanted to talk with them the member of staff knocked on the bedroom door and waited to be invited into the room. One resident preferred that their name was not shortened and one preferred that their name be shortened. They agreed that the way they were addressed was to their satisfaction. Letters were delivered to them promptly and unopened. A relative commented that each resident was treated with respect and accorded the dignity that should be given to elderly and frail people. Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A programme of activities provides residents with opportunities for stimulation and enjoyment. Residents said that they enjoyed the company of their visitors, who were made welcome by the staff when they visited the home. Residents said that they were able to exercise choice in their daily lives. Residents’ nutritional needs are met through the provision of a diet that is wholesome and varied. EVIDENCE: The home has an activities programme and forthcoming events include a pub lunch, a barbeque and entertainment and a picnic. One of the relatives said that their resident goes out on trips and joins in the activities and has said to the relative that she feels “spoiled”. Another relative said that they had helped Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 15 with an outing to Ruislip Lido by offering transport. Young men from a local school visit the home and play board games with the residents. We spoke with 4 residents about activities in the home. They spoke of ball games, board games, morning exercises, watching TV, reading and going for a walk. One resident that completed a survey form wanted to see more activities although they enjoyed the piano player that visited the home on a weekly basis. Residents confirmed that Holy Communion is celebrated in the home on a monthly basis. They said that residents could choose whether they wanted to take part in activities. One resident said that she liked to help out in the kitchen. When we spoke with members of staff one person said that they had been with 3 or 4 residents recently on a Thames boat trip and one of the residents that we spoke with said that she had taken part in outings. The member of staff also said that there was music and dancing as an activity. When we spoke with relatives each one said that they were always given a welcome when they visited the home and that they were offered refreshments. They confirmed that visits took place either in the lounge, the visitors’ room or in the resident’s bedroom. Relatives are encouraged to attend social activities and to join in the fun. A relative said that they had come to the barbecue, a coffee morning, Christmas activities and to a party for a resident celebrating their 100th birthday. Residents confirmed that their relatives receive a warm welcome when they arrive and a resident said, “the staff immediately offer refreshments and these are beautifully laid out”. We discussed with residents the choices they were able to make on a daily basis and they agreed that they were able to choose when they went to bed in the evening and when they got up in the morning. They were able to choose whether to take part in activities, what activities took place, what food they ate, whether they wanted to spend some quiet time in their room and where they entertained visitors. Residents are encouraged to be as independent as possible and a relative said that their resident helped to put the tablecloths on the dining tables before mealtimes. During the inspection we saw the serving of the lunch. The meal looked and smelt appetising. It consisted of a lamb casserole with potatoes, broccoli and peas. For dessert there was either melon or yoghurt. Alternatives to the main meal are available if a resident wishes. One resident preferred to have some soup and this was served. The home is able to cater for diabetic residents and 2 residents have a pureed diet. One of these residents said that the food was good. A cooked main meal is served at lunchtime and residents have the choice of a cooked light meal in the evening or sandwiches etc. We spoke with 3 residents about the meals served in the home and they all agreed that the food was “very good”. One resident said that it was “marvellous” and that the cook came round every morning to let residents know what was on the menu. They all agreed that alternatives were available and served, if the resident preferred. They also agreed that the menu was Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 16 varied and that the food is all home cooked. Snacks are offered at other times and drinks are always available. When asked on the survey form whether they liked the meals at the home 5 residents ticked “always” and 4 residents ticked “usually”. Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 17 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, 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A complaints procedure was in place and residents said that they were able to bring any concerns to the attention of the manager or to senior members of staff. Protection of vulnerable adults training for staff and familiarity with the home’s procedure contribute towards the safety of residents. EVIDENCE: We saw a copy of the home’s complaints procedure. It includes timescales for each stage of the process and gives contact details for the CSCI. A copy of the procedure had been placed in each of the bedrooms. The manager said that no complaints have been recorded since the last key inspection. Each of the members of staff completing a survey form ticked that they knew what to do if someone had concerns about the home and each of the residents that completed a survey form agreed that they knew how to make a complaint. However, 2 of the relatives that completed a survey ticked that they did not know how to make a complaint and 1 relative ticked that they couldn’t remember. When asked whether the service responded appropriately if they had raised any concerns 5 relatives ticked “always” and 2 relative ticked Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 18 “usually”. A relative said that if they ever had any concerns they were able to speak to the manager. Residents were confident about raising concerns with the manager and a resident said that there had been problems with the television in their bedroom and that it had been replaced by a “lovely new TV”. Another resident said, “The manager always listens”. The home has a code of conduct for members of staff and this precludes a member of staff accepting a gift from a resident or being a beneficiary in their will. There is a protection of vulnerable adults procedure in place. We saw that it had been reviewed in July 2007. Although the home has a copy of the local authority interagency guidelines in the event of abuse from Harrow it is a draft copy and is dated 2001. It is recommended that a copy of the final version be obtained. The manager said that no allegations or incidents of abuse have been recorded since the last key inspection. Members of staff have received training in adult protection procedures within the last 12 months. During discussions with members of staff they were able to explain to us their duties and responsibilities in the event of a disclosure being made and were aware of whistle blowing. Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 19 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, 26 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents enjoy comfortable surroundings although some redecoration and repairs would assure residents that they are being maintained to a good standard. Residents are assured of pleasant surroundings as good standards of cleanliness and odour control prevail. However, laundry facilities that are suitable where there is incontinence would assure residents of hygienic conditions. EVIDENCE: Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 20 During the inspection we looked around the home. We saw that some redecoration was needed as paintwork was scuffed and scraped in places. We also noticed that bedrooms did not have a lockable storage facility. On the second floor the bath had green stains (watermarks). A new chair was needed in one of the bedrooms and a drawer front needed to be re-attached. There were some lose threads on the carpet in the corridor. On the first floor there was a hairline crack on one of the walls in Room 9. The extractor fans did not come on when the light was turned on in the toilet and in the ensuite in Room 5. On the ground floor the extractor fan did not come on when the light was switched on in the ensuite in Room 1. The carpet in the lounge/dining room has some marks/stains. A relative said that the chairs in the home were replaced last year. A programme of redecoration was taking place and the manager said that some areas of the home had been repainted and that the decorators would be working again in the evening. Residents were satisfied with their rooms and one resident said that she had moved to a larger room since living in the home. Another resident described her room as “very nice”. All the residents praised the garden. One resident said that she spent hours in the garden and another resident said that it was beautifully laid out and that they liked to walk around the garden, which had plenty of seats where they could sit and rest or relax. When we looked around the home we noted that all areas were clean and tidy and that the home was free of offensive odours. All of the relatives that we spoke with confirmed that there was never any odour in the home when they visited and residents agreed, both during discussions with us and when completing a survey form that the home was odour free. One of the residents said that the cleaner did a good job in both the communal areas and bedrooms. Members of staff confirmed that they had received training about infection control procedures. The manager said that the washing machine programme did not contain a sluice wash cycle. Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are assured of sufficient staff on duty to meet their needs. However, covering the duties of the cook compromises the manager’s role. Residents would benefit from a service provided by carers that have demonstrated their skills and understanding through NVQ training. Generally recruitment practices protect the safety and welfare of residents although references from independent referees would assure residents of the reference’s validity. A comprehensive programme of training for staff encourages good working practices. EVIDENCE: We saw a copy of the rota and discussed this. Two statutory requirements had been made during the previous key inspection in regard to staffing levels and the need for the manager to have sufficient supernumerary hours to enable her to carry out her managerial role. The proprietor confirmed that a Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 22 proportion of the manager’s hours in the home are supernumerary and these consisted of 10 hours per week during the afternoons plus the remainder of 2 or 3 shifts during the week. However, on the day of the inspection the cook was on holiday and the manger had proposed to carry out the catering duties, before she knew of the inspection. There are 3 senior carers employed in the home and 1 of these is present during the day shifts. In total there are 3 carers on the early shift and 2 carers on the afternoon/early evening shift. At night there are 2 waking carers. All of the members of staff completing a survey form agreed that there were enough staff to meet the individual needs of the people using the service. Six residents completing a survey form ticked that there were “always” staff available when they needed them and 3 residents ticked “usually”. When asked about the care received residents said the staff are “very good” and “very patient”. A resident that uses the call bell during the night when they want to use the commode said that carers respond quickly. When relatives were asked whether the care service met the different needs of people (in terms of race and ethnicity, age, disability, gender, faith and sexual orientation) 6 relatives ticked “always” and 4 relatives ticked “usually”. It is recommended that training for carers include training about equalities and diversity. We spoke with the manager about NVQ training. The home is now below the target of 50 of carers achieving an NVQ level 2 or 3 qualification or equivalent. The manager said that this had occurred due to members of staff leaving the service. There is an equal opportunities policy in place and this includes the area of recruitment. The policy was reviewed in April 2007. We looked at the staff records for 4 members of staff. They each contained an application form, enhanced CRB disclosure, proof of identity (passport details), and the right to reside and to work in the UK had been established, where necessary. Although each file contained 2 references, a relative of the member of staff had supplied one of the references on a staff file. The home has a programme of training for staff and the induction training is based on the Sector Skills Council’s Common Induction Standards. We saw the induction training record for a newly appointed member of staff and noted that the supervisor and supervisee both sign after completion of each topic of learning. Training in safe working practice topics i.e. manual handling, food hygiene, first aid, fire safety and infection control procedures is given and then refreshed on a regular basis. Training is also given in specialist topics e.g. diabetes, dementia awareness and pressure care. When asked on the survey form whether members of staff had an induction that covered everything they needed to know to do the job when they started, 5 people ticked “very well” and 1 person ticked “mostly”. When asked whether Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 23 they are given training which is relevant to their role, helps them to understand and meet the individual needs of the residents and that keeps them up to date with new ways of working they all answered “yes” to each question. Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Continuing to undertake further training enables the manager to develop her knowledge, skills and understanding and to provide a service that is responsive to the needs of residents. Information gained through the quality assurance systems is used to shape the future development of the service and ensure that the changing needs of residents are met. Support is given to residents who need assistance in managing their finances so that residents’ financial interests are protected. More regular supervision for members of staff would assure residents of a service provided by people whose work practice is monitored and reviewed. Training for staff in safe working practice topics promotes the health and safety of residents, staff and visitors to the home. Certificates for all the testing and servicing of equipment and systems in the home would demonstrate that they continue to be safe to use. Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager has managed the care home for approximately 8 years and worked as a manager for 4 years prior to this. She has a good understanding of the needs of older persons and of motivating and supporting members of staff. She has a ‘hands on’ approach and residents are relaxed in her company. During the inspection there were a number of relatives visiting the home and they all popped into the office to say hello to the manager before meeting the residents. All of the relatives spoke highly of the manager and praised her caring manner. She has begun studying for an NVQ level 4 qualification but due to personal reasons had to take a break. She said that she would be restarting her studies soon. Since the last inspection she has undertaken short training courses/sessions in respect of challenging behaviour, protection of vulnerable adults procedures, first aid and supervision skills. There is a quality assurance procedure in place, which includes obtaining feedback from prospective clients about the pre-admission procedure, carrying out an annual quality assurance assessment and using both menu and activity questionnaires in the home. The questionnaires used in the assessment have been extended to cover a wider range of questions. There was a good response to the annual assessment (70 ) and when the information was analysed an action plan was drawn up for the home and 3 areas were identified i.e. outings, redecoration and care plans. We were given a copy of the analysis of the 2008 Quality Assurance Questionnaires. The manager has been responsible for identifying how improvements can be made and has already started to implement change. Comments made during residents’ meetings, which are held twice a year, have helped to shape an activities programme, redecoration has started in the home and the new care plans have been drawn up. It is recommended that relatives be informed of how their comments made during the quality assurance process will be used to develop the service. There are also opportunities for residents to give feedback during informal chats with the manager or formally during review meetings. Relatives visiting the home enjoy an “open door” policy with the manager or are able to leave her message if she is off duty. Members of staff are able to give feedback during quarterly staff meetings or to the proprietor during the Regulation 26 visits. The manager draws up an annual development plan for the home and a copy of the plan dated November 2007 was available. She also carries out her own Quality Assurance assessment of the home and sends a copy of this to head office. Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 26 One of the residents manages her own finances. Records are kept of money held on behalf of any resident. These were up to date and satisfactory. They included all transaction details and had a balance after each transaction. Receipts were kept for items of expenditure. We discussed with the manager a statutory requirement that had been made during the previous inspection. This was about the need for members of staff to receive regular, recorded, individual supervision sessions. A programme has been set up but due to the manger being absent from the home for a period of time due to personal reasons the regularity of the sessions needs to be increased from quarterly to every 2 months. When asked on the survey form whether the manager meets with the member of staff to give them support and to discuss how the member of staff is working, 5 people ticked “regularly” and 1 person ticked “often”. One member of staff went on to comment that the manager is approachable and makes time to listen and to support them. The manger will show appreciation if the member of staff works well and if the member of staff makes a mistake the manager will be the first to encourage the member of staff to set things right. Training in safe working practice topics is arranged on an annual basis and given to new employees and to members of staff that need refresher training according to good practice guidelines. A copy of the letter sent by the LFEPA, following their inspection of the home in February 2008, confirmed compliance with regulations and standards. The home has a fire risk assessment and this was updated in July 2007. We saw risk assessments for health and safety, in the workplace, individual bedrooms and COSHH. There were valid certificates available for the servicing/checking of the fire extinguishers, the hoists, assisted bath, boiler, portable electrical appliances, fire alarm system, and lift. The Landlords Gas Safety Record was not available and there was no confirmation/evidence that the remedial work required on the electrical wiring installation (following the inspection in 2004) had been carried out. A copy of the employers’ liability insurance certificate was on display in the home and was due to expire on the 27th June. The proprietor said that the matter had been dealt with and that a new certificate would be sent to the home. Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 15(2) Requirement To make sure that the resident’s care needs are identified and addressed the manager must make sure that the care plan is reviewed on a regular basis i.e. every 6 months. To make sure that the resident is assisted with transfers safely their manual handling risk assessment must include details of the intervention and any equipment needed. To make sure that residents enjoy pleasant surrounding the making good and decoration that is needed and that was identified during the site visit must be included in the ongoing programme of redecoration. To make sure that all parts of the home used by residents are appropriately ventilated the extractor fans that were not working must be repaired. To make sure that the carpets in areas used by residents are in a good condition the carpet in the lounge must be cleaned or replaced. DS0000017549.V364439.R01.S.doc Timescale for action 01/11/08 2 OP7 13(5) 01/09/08 3 OP19 23(2) 01/11/08 4 OP19 23(2) 01/09/08 5 OP19 16(2) 01/11/08 Manor Lodge Version 5.2 Page 29 6 OP19 23(2) 7 OP26 23(2) 8 OP27 18(1) 9 OP28 18(1) 10 OP29 19(1) 11 OP36 18(2) 12 OP38 13(4) To make sure that all bathing facilities for residents are pleasant to use the bath on the second floor must be cleaned/repaired or replaced. To make sure that sluicing facilities are available for residents’ laundry the washing machine must be replaced. To make sure that the manager is available to supervise and monitor the quality of care in the home a replacement cook must be provided when the cook is absent. To make sure that residents are supported and cared for by members of staff that have demonstrated their skills and understanding the home must reach the target of a minimum of 50 of carers with an NVQ level 2 qualification. To make sure that unsuitable persons are prevented from working in the home the practice of accepting a reference from a member of the applicant’s family must cease. To make sure that staff are supported and supervised and that the quality of their work is monitored the regularity of supervision sessions must increase to a minimum every 2 months. To make sure that all equipment and systems in the home are safe to use a copy of the Landlords Gas Safety Record and confirmation that the remedial work to the electrical wiring installation was carried out must be available in the home. Copies must also be forwarded to the CSCI. 01/11/08 01/11/08 01/09/08 01/01/09 01/09/08 01/10/08 01/09/08 Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 30 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 3 4 5 6 7 8 Refer to Standard OP3 OP7 OP8 OP16 OP18 OP19 OP27 OP33 Good Practice Recommendations That the home asks the funding authority to confirm referral information in writing during the pre-admission process. That the monthly evaluations of the care plans are in greater detail. That the home arranges for another dentist to provide dental care to the residents. That the home reminds relatives of the complaints procedure. That a copy of the final version of the local authority interagency guidelines in the event of abuse is obtained. That there is a lockable storage facility in each of the bedrooms. That members of staff receive equalities and diversity training. That feedback is given to relatives about the results of the annual quality assurance assessment and how their comments have helped towards the development of the service. That residents’ meetings are held on a monthly basis, That staff meetings are held on a monthly basis. 9 10 OP33 OP33 Manor Lodge DS0000017549.V364439.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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