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Inspection on 28/04/09 for The Manor House Care Home

Also see our care home review for The Manor House Care Home for more information

This is the latest available inspection report for this service, carried out on 28th April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the people who use the service who live there. The living environment is appropriate for the particular lifestyle and needs of the service users and is homely, clean, safe and comfortable. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective person. The management team considers all the information about the prospective person. People who use the service and their relatives are confident that complaints will be taken seriously and acted upon. Contact is maintained with their friends and relatives and service users can exercise choice and control over their lives. One person living at the service commented, `The staff are good and the manager`s good`. One relative said, ` My relative`s health has improved with staff care, they are lovely`.

What has improved since the last inspection?

The manager has now created a comprehensive pre admission assessment which ensures people will have their needs met by the staff. Recruitment practices have improved and all staff have suitable checks made prior to starting work at the home.

What the care home could do better:

The manager must improve the information on care plans to provide detail on how staff are to care for each identified need to ensure the safety of the person is maintained. An improvement in the number of hours the manager is employed to carry out management duties would ensure she has sufficient time to create the detailed plans that are needed for people who use the service.

Key inspection report Care homes for older people Name: Address: The Manor House Care Home Brook Street Sutton In Ashfield Mansfield Nottinghamshire NG17 1ES     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: Susan Lewis     Date: 2 8 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Manor House Care Home Brook Street Sutton In Ashfield Mansfield Nottinghamshire NG17 1ES 01623554552 01623554552 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Thambithurai Raj Chandran,Dr Sudaram Rai care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 25 The registered person may provide the following categories 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: Older Persons Code OP Dementia - Code DE Date of last inspection Brief description of the care home The Manor House is a care home providing personal care and accommodation for 25 older people. The home provides short term, long term and respite care and can accommodate emergency admissions. The home is owned by Dr Chandran and Dr Rai and is run as part of a small business. The home is located near the centre of Sutton in Ashfield close to shops, pubs, the post office and other amenities. The home was opened in 1997 and consists of an extended house. All of the homes bedrooms are Care Homes for Older People Page 4 of 26 Over 65 0 25 25 0 Brief description of the care home single, and the majority of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors and there is a passenger lift. There are gardens to the front of the property and a small car park to the rear. There is a ramped access to the front door and most areas of the home are accessible to wheelchair users. The home does not provide a structured programme of activities. The manager said on 28/04/09 that the fees for the service range from 366 pounds- 379.79 pounds per week depending on dependency needs. There are additional charges for hairdressing and chiropody. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for residents and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. One inspector conducted the unannounced visit over eight hours. The main method of inspection used was called case tracking which involved selecting three residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The registered manager, and members of staff were spoken with as part of this visit. Documents were read as part of this visit and medication management was inspected Care Homes for Older People Page 6 of 26 to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken which included a sample of residents bedrooms, to make sure that the environment is safe and providing appropriate aids. A review of all the information we have received about the home and the previous requirements that were set at the last inspection was considered in planning this visit and this helped decide what areas were looked at. The manager returned her Annual Quality Assurance Assessment, referred to in this report as pre inspection information, this provided good information on the services provided. The quality rating for this service is 2 star this means the people who use this service experience good quality outcomes. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions only take place following an assessment and the service is confident that the staff have the skills to meet the persons needs. Evidence: Three peoples care plans were viewed for the purpose of this inspection including a person who had recently been admitted. The assessment covered all aspects of daily living including their social interests and hobbies personal care and physical well being as well and the manager also ensured that a copy of the persons assessment carried out by the social worker was obtained to help inform the care plan. A requirement was set at the last inspection to ensure that people are fully assessed prior to moving to the service. This is now met. Care Homes for Older People Page 10 of 26 Evidence: The pre inspection information also said that detailed information was now available for all people interested in moving to the home. The service does not provide intermediate care. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans continue to lack detail and there is potential risk that people who use the service may not have all their needs met. People who use the service are treated with respect and dignity. Evidence: Pre inspection surveys were sent to the home and information from those returned were used in this report. People who use the service were asked if they received the care and support they need and all those who replied said that they did. and that staff were available when they needed them. We looked at three care plans, the written recorded information about the needs of people who use the service were not comprehensive and there were shortfalls in assessing risks where people had particular health care needs. An example of this was where the assessment said that a person had epilepsy yet there was no mention of this in the care plan. There is potential that this could place people at risk of not Care Homes for Older People Page 12 of 26 Evidence: having their health needs met. Staff spoken with said that they used the care plans to find out how to care for a person as well as information given at handover at the start of each shift. The staff were asked in the surveys if they were given up to date information about peoples care needs and four of the five staff who replied said that they always received the information and one replied usually. We saw evidence in the plan that they were reviewed regularly and that where possible the person was involved. The pre inspection information stated that plans are created involving the person and family, evidence of this was seen on care plans. During the inspection the we heard the manager talking to staff about how care plans should be improved and what they were going to do to achieve this. A requirement was made at the last inspection to ensure that people who use the service have up to date care plans to ensure their needs are met. This has not been fully met. Six people who live in the service and four relatives were spoken with during the course of the inspection and all expressed satisfaction with the service. I think we are very well cared for you can have a laugh and a joke with the staff its not all serious. Its the best place Ive been in. I like living here they look after me well, staff are kind to me. I think this is an excellent place staff are very caring and I am really pleased I found this place for my relative. People were asked in the surveys if the home makes sure they get the medical care they need and four of the five who replied said always and one replied usually. People who use the service had access to external professionals such as the District Nurse and General Practitioner and any equipment necessary to support their conditions such as pressure cushions. We looked at how medicines were managed and found that trained staff manage this Care Homes for Older People Page 13 of 26 Evidence: well. Medicines were stored safely and recorded into the home as required, the hand written medicine record sheets had been signed and witnessed to reduce any error. We observed good practice with staff speaking to people who use the service in a friendly manner and people confirmed that staff treat them with respect and maintain their dignity when providing personal care. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to spend their time as they wish to. There are activities provided to meet their cultural and social needs. They receive a wholesome and appetising diet. Evidence: We found that there are suitable activities provided and attempts to provide a service that is as individual as possible, using staff and resources effectively. Although some staff did respond to the surveys saying they felt more could be done in providing activities for people who use the service. In surveys people who use the service were asked if the home arranged activities. Three people replied that the home always did, one said sometimes and one said usually. The pre inspection information gave us information that people who use the service are consulted on how the home can work to provide them with a flexible lifestyle, the home has listened to their views and has made some changes to the events provided. During this inspection a sing along was taking place and friends and relatives who Care Homes for Older People Page 15 of 26 Evidence: were visiting the home were encouraged to take part along with people who use the service. The information within the pre inspection information told us that the manager recognises and works towards equality and diversity for all service users in respect of age, gender, religion, and culture. We observed the midday meal and this was appetising and plentiful. We spoke to people who use the service and they said that they enjoy the food and they are always given a choice and had plenty of it. Three of the five people who replied to the survey said that they always liked the meals the home provided and the other two said that they usually liked them. The cook was able to demonstrate how people with specialist diets are catered for including where a person has gluten intolerance the cook make the bread and cakes for the person. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service feel safe and able to complain. Evidence: From the pre inspection information and from evidence during this site visit it is evident that the service has a suitable complaints policy. People who replied to the surveys said that they knew who to speak to if they werent happy with the service. All the relatives who responded said that any concerns raised were responded to appropriately. In discussion with people who use the service and their relatives it was clear that everyone knew who to raise any concerns with and all felt that the manager would listen to their issues. We have not received any complaints about the service and the manager told us of one complaint the she had received this was looked at and had been dealt with following the services policy and procedures with a satisfactory outcome. People who use the service told us they felt safe and well cared for and relatives said they felt that they were leaving their loved ones in a safe place. The service has procedures in place to ensure that people who live in the service are Care Homes for Older People Page 17 of 26 Evidence: free from abuse. Staff spoken with said that they receive training and understood what was abuse and knew what to do if they suspected it. Training records show that staff had received both safeguarding adult training and managing challenging behaviour training this ensures staff are able to respond to incidents of aggression safely. Care Homes for Older People Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical environment meets the needs of the people who use it. Evidence: This inspection found that the environment was very clean and generally well maintained, however there were some areas where wall paper was hanging off. The manager is aware of this and is in discussion with the providers to redecorate at a suitable time. There are sufficient cleaning staff employed to maintain the cleanliness of the building and a maintenance person is also employed to carry out maintenance of the building and garden. Staff have recently had infection control training and staff were observed following correct practice. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient trained staff on duty to meet the needs of the people who live in the home and maintain their safety. Recruitment is robust and protects people who use the service. Evidence: The duty records were seen and confirm that there are care staff, catering, laundry and cleaning staff employed on a daily basis. The manager told us she has recently increased the number of staff from three to four in the morning to cover the busy period of the morning and then to enable staff to spend time in supporting people who live at the service in activities. The manager was on duty during the inspection. In discussion with her it was clear that a requirement set at the last inspection to increase the management hours from 30 hours a week to enable her to carry out all her management duties has not been met. This is impacting on the people who live in the home in that the manager is unable to create the detailed care plans to ensure that all aspects of their care can be met. People who use the service said that staff responded quickly to them when they called Care Homes for Older People Page 20 of 26 Evidence: them, but relatives did feel there should be more staff available to take people out more frequently. From pre inspection information and from training records seen it was clear that most staff have their National Vocational Qualification level 2 or are working towards it. There are two staff with National Vocational Qualification Level 3 with a further four workings towards it. Recruitment procedure checks identified safe practice in obtaining 2 references and Criminal Record Disclosure for all staff prior to commencing employment. This had been a requirement at the last inspection and is now met. The staff also receive a suitable induction to ensure they are competent to undertake care duties. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is run in the best interests of the people who live there. Evidence: The manager is registered with us and as such has been assessed as having the required qualifications and experience and is competent to run the home. The manager demonstrates through discussion with us and within the pre inspection information that she understands person centered planning and thinking but she has little time to implement good care planning, she is trying to work towards introducing a new care planning system but this could take considerable time as she has no administrative support. The manager supports and helps develops staff that are generally competent and knowledgeable to care for the residents. The service focuses on the individual, takes account of equality and diversity issues, and generally works in partnership with Care Homes for Older People Page 22 of 26 Evidence: families or close friends, as appropriate, and professionals. People who use the service and families are surveyed by the home to encourage their suggestions for improvement and the manager demonstrates within the pre inspection information that their suggestions are listened to and acted upon, such as improving the social activities. We looked at a selection of maintenance documents and these showed that the manager ensures that the home is regularly maintained and safe for people who live and work there. The arrangements in respect of peoples finances were checked to ensure their interests are being protected. The records tallied with the amounts held on the premises and there were receipts for expenditure indicating the arrangements are well organised. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 27 18(1)(a) Sufficient management hours 01/06/2007 must be allocated to make sure all management tasks are fully completed. This will ensure that residents live in a well run home. Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 7 15 Ensure that care plans are 26/05/2009 developed and identify all the needs of the people who use the service in sufficient detail. This will enable staff to provide comprehensive care. 2 27 1 Sufficient management hours 30/06/2009 must be allocated to make sure all management tasks are fully completed. This will ensure that residents live in a well run home. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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