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Inspection on 10/11/09 for The Manor House Nursing Home

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

This is the latest available inspection report for this service, carried out on 10th November 2009.

CQC 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.

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 home provides a comfortable and homely place for people to live. People appear to be well supported by staff in meeting their personal care needs. One person who lives at the home told us in a survey that the home is "nice and clean, worth coming to, good grub, very satisfied". When we asked what the service does well, relatives told us: "Personal caring. Knowing when to call GP, always being available to talk to me" "They undertake a difficult job with sympathy, concern and conscientiousness". "I am always advised of any important matters, whenever I attend I am always made to feel welcome" A health care professional involved in the care of people at the home told us that the home is well managed with "well qualified and caring staff" We saw that the home operates a safe system for administration of medication and that staff know how to keep people safe.

What has improved since the last inspection?

The home has developed their systems for monitoring the quality of care and services they provide. They have sent surveys to people to give them the opportunity to say how they feel about the home and are considering other ways in which they can better involve people to make sure that the home is run in the best interests of the people who live there.

What the care home could do better:

Care plans would benefit from being written in plain English without medical jargon and abbreviations. This will make sure that care plans are a working document and easily understood by the individual concerned and all of the staff involved in their care. People should be consulted about activities they would like to see in the home on a daily basis and staff made available to support people in meeting their social and leisure needs. To help staff in developing their skills and therefore possibly improve people`s comfort and safety, staff could undertake practical training to support their other learning.

Key inspection report Care homes for older people Name: Address: The Manor House Nursing Home 127 Wakefield Road Lightcliffe Halifax West Yorkshire HX3 8TH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Gillian Walsh     Date: 1 0 1 1 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 Nursing Home 127 Wakefield Road Lightcliffe Halifax West Yorkshire HX3 8TH 01422202603 01422204113 oliverjamesthomas@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Jean Thomas care home 31 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: 31 The registered person may provide the following category of service only: Care Home with Nursing - Code N, To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places 31 Date of last inspection Brief description of the care home The Manor House Nursing Home is a comfortable home providing nursing care for up to 31 older people. It is set in its own attractive, well kept grounds with pleasant outside seating for people to use in the better weather. There is plenty of car parking and the home is on a bus route. The bedrooms are mainly single occupancy but there are some shared rooms and the communal rooms are spacious and attractive. The home is well furnished and kept in good decorative order. The manager said that the fees in November 2009 ranged from £467.50 - £512.00 per week. Care Homes for Older People Page 4 of 26 Over 65 31 0 1 3 1 1 2 0 0 8 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out to assess the quality of care provided to people living in the home. The inspection process included looking at the information we have received about the home since our last key inspection as well as a visit to the home. One inspector carried out the visit over one day and it lasted for approximately 6 hours. During the visit we spoke to people living in the home, some visiting relatives, some members of staff, the manager and wider management team. We observed care staff delivering care, looked at various records and looked around the home. Before the visit we sent surveys to 10 people living in the home and their relatives, 5 staff and 5 health care professionals involved in the care of the people at the home. This gives people the opportunity to share their views of the service with us. Care Homes for Older People Page 5 of 26 Information received in this way is shared with the home without identifying who has provided it. We received completed surveys from 5 people living at the home and their relatives, 2 health care professionals and 4 members of staff. Their comments have been used in this report. We asked the manager to complete an Annual Quality Assurance (AQAA) document so that she could tell us how she thought the home was doing, any improvements they have made or have planned and any problems they may be facing. The document also provides us with some numerical information about the home to assist us in our inspection process. The AQAA was completed and returned to the Commission within timescales. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 6 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. Care Homes for Older People Page 7 of 26 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. People do not move in without an assessment to confirm that the home is the right place for them and staff have the skills to meet their needs. Evidence: The manager said that before anybody comes to live at the home, wherever possible, they and their relatives are invited and encouraged to come and have a good look around to see if they think the home is suitable for them. The person thinking of moving is also invited to spend some time at the home and join the people who already live there for a meal. The manager said that she will also, wherever possible go to visit the person in their current environment whether that be home or hospital to make an assessment of their needs. Care Homes for Older People Page 10 of 26 Evidence: The manager showed us a new form which is to be used to record their assessment of prospective residents needs and preferences about their care. In addition to this the home makes sure that they have received a copy of the social workers or hospitals assessment. This will make sure that people are only admitted to the home if it has been confirmed that staff have the skills to meet the persons needs and that the environment is right for them. The home 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. Staff meet peoples health and personal care needs appropriately and with discretion. Evidence: We looked at four peoples care files during the visit to the home. We saw that each file contained a care plan with the persons needs identified under the activities of daily living headings. These include washing and dressing, mobility, eating and drinking and socialisation. The care plans were written within a good framework but some lacked specific detail and clear instruction to staff. An example of this is where a care plan said encourage plenty of fluids. The care plan did not say how staff were to encourage fluids or how much fluid the person should be having. Another example is where the care plan said observe for signs of infection, obtain MSU and treat accordingly these instructions do not tell staff what the signs of infection are or what treat accordingly means. We also noticed that care plans are written by the nursing staff and contain terms and abbreviations that may not be understood by the person for whom the care plan has Care Homes for Older People Page 12 of 26 Evidence: been written or the care staff. An example of this is where the care plan said H/O DVT. This may not be understood by any person without medical training. Care staff told us that they are told what is in the care plans and any changes in peoples care but do not actually read them. Our observations and the things people told us confirm that care staff do appear to be aware of peoples needs and how to meet them. However, as care staff deliver the majority of the care to people, they should have some involvement in the planning of care and be able to read and refer to the care plans on a daily basis. Choice and preference was not included in the majority of the care plans. An example of this was one care plan which said staff to wash and dress the person. There was no detail of where or when the person preferred to wash, what toiletries they liked to use or other personal care tasks that would be involved such as shaving or hair and teeth care. Where care plans included peoples choices and preferences this was done well. For example one care plan said that the person liked to have a bedside lamp on all night. We saw that risk assessments had been developed in areas such as pressure area care, falling and nutrition. We saw from the care files that the support of health care professionals is sought as necessary. this includes general practitioner, district nurse, community mental health care nurses and social workers. A health care professional involved in the care of people living at the home told us in a survey that they are happy with the care provided by the home. We saw that the care plans included moving and handling plans and observed staff working in accordance with these plans. We saw some people who, due to their condition were in bed. They looked comfortable and well cared for and the relatives of one of these people said they were very satisfied with the care provided by the home. We observed care staff treating people with respect and discretion and saw that people looked clean, tidy and well cared for. The hairdresser was in the home during the visit attending to both ladies and gentlemans hair. We observed a medication round and looked at systems for storage of medication. We saw that staff operate safe systems with regard to medication. Care Homes for Older People Page 13 of 26 Evidence: 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People need more support to follow their chosen lifestyles and to meet their social and leisure needs. People enjoy the food at the home. Evidence: The care plans we saw contained a life history which gave staff a good insight into the individuals background, family life and social interests. Care plans had also been developed for peoples social and leisure needs but little had been included in the care plans about individuals preferred daily routines and personal preferences in relation to such as food and drink, clothing and personal care. We did not see organised activity taking place during the visit and the manager said that the home does not employ staff dedicated to engaging people in activities. People were seen reading magazines and newspapers, listening to music or watching television. Two of the people who live at the home said that they would like more to occupy their time. Care Homes for Older People Page 15 of 26 Evidence: People told us about a recent Halloween party and an event to celebrate bonfire night. We observed the lunchtime meal being served which looked appetising and nutritious and saw that people were offered choice. One person was being assisted to eat a liquidised meal which did not look appetising as all of the components of the meal had been liquidised together. When a person needs to have their food liquidised, to make the meal look appealing and for the person to identify different tastes, all the components should be liquidised and served separately. One relative who responded to our survey and some relatives spoken to during the visit said that they were made to feel welcome at the home whenever they visited. 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 are safe in the home but allcomplaints and concerns must be recorded and dealt with appropriately. Evidence: People who live at the home and their relatives told us in surveys that they knew how to make a complaint should they need to. One person who lives at the home said never thought of complaining but would just say if need to We saw from one persons daily records that they had raised a concern about the care of other people who live at the home. Staff had recorded in the persons daily records that the issue had arisen through a misunderstanding but had not made record in the complaints/concerns book and therefore there was no evidence to show that the issue had been looked into according to the homes procedures. The entry in the daily record was of some concern as it suggested that the person concerned had almost been chastised for making a complaint. Staff records showed that all staff have recently undertaken training in how to recognise abuse and how to keep people safe. Staff spoken with were clear about how to recognise abuse and what they should do if the situation arose. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and comfortable home. Evidence: During the visit we walked around the communal areas of the home and looked in some bedrooms. People told us in surveys that the home is always clean and tidy and we found that to be the case. Communal areas had a homely and comfortable feel and several people were enjoying sitting in the conservatory which was appropriately heated. One of the owners told us of their plans to refurbish some of the rooms and to put en suite facilities into some of the bigger rooms. The majority of shared rooms are now being used as single rooms. Some of the people living at the home had personalised their rooms with their own furniture and personal items. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a caring team of staff who have been appropriately recruited and trained to meet the needs of people in their care. Evidence: Staff on duty told us that they feel that they have time to meet the needs of the people living at the home. However two of the staff who responded to our surveys said that there are usually enough staff on duty. There are times during the day when the staff rota shows that there are only two staff on duty. As there are several people living in the home who need two staff to meet all of their care needs, this means that when any of these people are being attended to there are no staff available for all of the other people. We saw that staff are kind and discreet in their interactions with people. People we spoke with, including relatives, were very complimentary of the attitude and the work of the staff. We looked at staff files to see if they were being recruited safely. We saw that all appropriate clearances and references obtained before a job offer is made. We saw that one person had an employment gap of several years but we did not see any explanation for this. We discussed the importance of exploring such gaps in Care Homes for Older People Page 19 of 26 Evidence: employment with the proprietor of the home. Staff training records show that staff have undertaken recent training in a number of areas including medication, safeguarding, moving and handling and safeguarding. The majority of this training is done by watching a video but staff may benefit from more practical training in some areas. Staff told us in surveys that they feel well supported by the manager. The provider told us in the AQAA that nine of the sixteen staff have achieved the National Vocational Qualification (NVQ) level two in care. This means that staff are trained to meet the needs of the people in their care. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management processes are good and the improved quality monitoring processes mean that people can be confident that the home is run in their best interests. Evidence: The manager is a registered nurse and has obtained the registered managers award. She is supported by the wider management and administration team which allows her time to work alongside the care staff in delivering hands on care to the people who live at the home. During the visit we saw a number of surveys which the home had sent out to people involved in the home in order to get their opinion on the quality of care and service the home delivers. The results of these surveys were very positive. The homes owner said that they were continuing to develop their quality review Care Homes for Older People Page 21 of 26 Evidence: processes and showed us new documentation which they have developed to encourage people to discuss their views about the way the service operates. Prior to the inspection, the Commission sent an Annual Quality Assurance Assessment known as an AQAA to the service for them to complete and return. This document gives the service the opportunity to tell us how they feel they are doing, any problems they are encountering and how they plan to improve and develop the service they provide. The home returned their completed AQAA within timescales and included a lot of information. The AQAA is also used to tell us about how the home is being maintained and what safety checks have been completed. The AQAA confirmed that all safety checks are up to date. The home does not hold or manage any monies on behalf of the people who live there. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans should be written clearly in language that can be easily understood by the individual concerned and all care staff. Care plans should be a working document and used by all staff involved in the persons care on a daily basis. This is to make sure that people received the care they need in the way they prefer. 2 3 12 14 Staff should have time dedicated to engaging people in their chosen social and leisure activity. Peoples needs and preferences in relation to their routines and social and leisure activities should be recorded in the care plan so that staff know what actions they can take to support people in their chosen lifestyles. Liquidised meals should be presented attractively and in a way in which the person can identify individual tastes. Staff must make sure that when people raise a concern or complaint, it is reported, recorded and dealt with according to the homes policy. Page 24 of 26 4 5 15 16 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations This is to make sure that people have confidence that they are being taken seriously. 6 27 The manager should keep staffing under review to make sure that there are always enough people on duty to meet the changing need of the people living in the home. Gaps in the employment history of potential employees should be explored and notes made of the explanation in the recruitment file. This is to make sure that the person is suitable to work with vulnerable people. Practical training in areas such as moving and handling should be arranged so that staff can be assessed on their practical skills in making sure people are cared for safely. 7 29 8 30 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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