Inspection on 21/11/05 for 9 Manor Road

This inspection was carried out on 21st November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

9 Manor Road 21/08/08

9 Manor Road 23/08/06

9 Manor Road 06/05/05

9 Manor Road 28/02/05

9 Manor Road 15/01/05

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 9 Manor Road 9 Manor Road Leamington Spa Warwickshire CV32 7RJ Lead Inspector Warren Clarke Unannounced Inspection 21st November 2005 09:30 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 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 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 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 Adults 18-65. 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. 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 9 Manor Road Address 9 Manor Road Leamington Spa Warwickshire CV32 7RJ 01926 832552 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) Eden Place Limited Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th May 2005 Brief Description of the Service: 9 Manor Road is part of the Eden Place group of homes. It is a mid-terraced property approximately two miles from Leamington Spa town centre. The home has three bedrooms on the first floor and a lounge, dining room and kitchen on the ground floor. The bathroom is also on the ground floor at the rear of the kitchen. The home accommodates up to three persons in single room accommodation. The communal space is shared. There is a back garden area leading to an entry. The home offers accommodation to persons with mental health problems. The service is designed for service users that are self-caring in meeting their physical needs and require minimum support to maintain their mental health. Housekeeping services are provided to carry out domestic duties.The residents have a limited amount of support from staff and qualified mental health nurses from Eden Place Nursing Home. The nursing home is close by (approximately 50 yards) and within a few minutes walking distance for the residents. 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection is the second carried out during this inspection year and it was focused mainly on the areas where deficits were identified at the last inspection. The Manager and another member of staff who works exclusively in the Home were present and were interviewed. In carrying out the inspection the service users were seen and interviewed informally. Observations were also made of their interaction with staff and how they coped when no staff members were present on the premises. As usual, relevant records were examined and the condition of the premises and its facilities were assessed. Note this is a small care home, which is affiliated to a larger establishment, a nursing home, which is located in an adjacent street opposite the rear of the premises. Service users in the Home were previously residents of the nursing home, but were transferred because they are deemed to be less dependent and need an environment more akin to normal home life to aid recovery and possible rehabilitation. It is against this background that the Home was inspected. Throughout the report the Home is used to represent the establishment being inspected; service users refers to those being looked after at the home and the standards and the regulations relate to the National Minimum Standards for Younger Adults and Adult Placements, and the Care Homes Regulations 2001, respectively. What the service does well: What has improved since the last inspection? 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 6 At the last inspection some deficits were identified in regard to the living environment, i.e., the condition of the bathroom floor; an issue with heating and ventilation in one of the bedrooms and some matters related to honing some practices, procedure and aspects of administration. All of the matters relating to the deficits in the living environment have been addressed and all the other issues have either been resolved or work has commenced but has not been completed. This is most encouraging as previously there was evidence of a lax approach to fulfilling requirements made in relation to deficits identified. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 A more systematic approach to the assessment of service users is now having the effect of showing their needs more clearly, informing their care plans such that their care is provided with greater precision and with requisite focus on their lifestyles and aspirations. Service users now have a more simplified yet detailed Residence Agreement with the Home. EVIDENCE: At the last inspection it was considered that whilst there was sufficient information about each service user’s circumstances and needs, this information was not being brought together in a sufficiently systematic way to provide a holistic assessment picture. There is now recognition within the Home that service users, who have been there for some time, need to have a comprehensive reassessment periodically, and an acceptable attempt has been made to do this. A new assessment format and the imminent revision of it, which has been planned, brings together the service users’ health and personal care needs with that of their past lifestyles – social and leisure interests, independent living skills, communication and their social skills, education, training, employment or meaningful occupation. In essence, staff members are assessing service users past strengths and difficulties against those of the present in order to help chart the course for their future development. This is reflected in their individual plans for which there was evidence of review and understanding that they need to be updated in light of assessment of the 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 9 individual service users’ changing needs and progress. One service user was able to explain in reasonable detail something of that individual’s situation and what the Home is doing to assist. These developments together with the more positive aspects of the assessment and care management process seen at the previous inspection have, in the inspector’s judgement, fulfilled the demands of standard 2 and the requirement, which was made at the last inspection. A number of complex documents, which previously formed the Resident Agreement have been condensed into a single document and presented in a form, which is likely to be better understood by service users. The new document sets out the facilities and services the service users can expect and what is in turn expected of them. The scales of charges are specified so that the service user now knows exactly how much is being paid in weekly fees and what is or is not included. The service user guide summarising how the Home is intended to be run, is appended to the Residents’ Agreement so as to provide each service user with the fullest information. Together, the measures outlined above should ensure that service users and/or their representatives have the necessary information to determine whether the Home is fulfilling its obligations in regard to the service users’ accommodation and care and, indeed, whether they are getting value for money. In this connection, the Home now faces an interesting dilemma – that is, some service users are reluctant to engage in some domestic tasks such as cooking, which is intended to be part of their treatment to recover some of their independent living skills. The Manager says that service users now argue that they pay (i.e., their fees) to have these tasks done for them. Whilst this was not the intended outcome, it nevertheless illustrates that, at least, some service users are empowered by the new information in their Residents Agreement and the way it is now presented. Accordingly, the requirement which was made in this regard at the last inspection has been met. 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Service users are being enabled to live full, participative lives as a means of aiding their recovery and thereby restoring something of their independent lifestyle, which involves some reasonable risks. EVIDENCE: The Home is a small facility – a terrace house of three bedrooms equipped on a domestic scale and operated so as to enable service users to live as independently as possible. Two members of staff are employed to support the service users, one who assists with housekeeping and another who provides guidance and support in relation to social, occupational and leisure activities. Staff’s input being centred on guidance and support means that service users are enabled to establish their own daily routines and make decisions about their own lifestyles. For example, they go to bed at night and wake up at reasonable times of their choice. They manage their own finances and are provided with information about the local advocacy service. This information is readily available should they wish to access independent advocates. As reported at the last inspection, service users are kept informed of all aspects of the running of the Home and demonstrate this in being able to explain to the inspector how it is operated on a day-to-day basis. They, for 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 11 example, explain the catering and housekeeping and maintenance arrangements and are able to refer to the notes of fortnightly residents meetings at which routine matters and proposed developments are discussed and agreed. Further evidence of the extent to which service users participate in and influence the way the home is run, was evident when one of them accompanied the Manager and the inspector on the inspection of the premises and advanced views about how certain decorative improvements to the communal areas should be done. Currently all service users in the Home are able to communicate effectively and staff are keen for them to develop assertiveness in expressing their views about the running of the Home. This is because they believe this is service users’ intrinsic right, but also as a valuable aspect of their treatment/recovery plan. In this connection, they are mindful of seeking service users’ views through customer satisfaction questionnaires as required by standard 39, which is allied to this, standard 8. The Manager explained that he has decided to discount the results of the last service users and stakeholder satisfaction questionnaire, as new information had come to light, which had given cause for doubt about their integrity. Plans have been made to re-administer the questionnaire next year. The main risk associated with the way the Home is run and the level of independence that it provides service users is that there are no staff members present on the premises at night. Effectively, from approximately 1pm to 8am the only access that service users have to staff is either telephoning or walking across the road to the Home’s core unit, a nursing home. At the last inspection the Manager was required to assess the potential risks in this arrangement and, as necessary, to introduce measures to eradicate or reduce any risks identified. The Manager, reported that risk-assessment did not reveal any untypical danger. That is, this way of working has been in place for some time and the service users have shown that they are able to contact staff at the nursing home when necessary. Furthermore, in the event of fire, service users are well drilled in the fire procedure and neighbours have been alerted to this as a potential risk and have agreed to assist. The Manager was advised to test drill/arrangement with neighbours during out of normal hours periods, from time to time. It might also be prudent to advise the Fire Service of the arrangements. 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, 16 and 17 Service users who wish, have opportunities, and are encouraged, to maintain contact with their families and friends and to establish friendships both within and outside the Home. The Home is also run on a basis that recognises service users adult status and their right to be treated with dignity and respect. Service users benefit from catering arrangements that provide them with the food that they prefer and a wholesome diet, but which could be more varied. EVIDENCE: At the last inspection it was assessed that the range of occupational and leisure activities in which service users were engaged was limited though this was not because of any restrictions placed upon them. Since then resources have been invested in this aspect of care, in the form of an additional staff member and transport to facilitate service users becoming more active and stimulated in terms of their meaningful occupation and leisure. One service user explained that since the last inspection they had been out on service trips to places of interest and staff have attempted to find out the kind of hobbies and leisure interests that they used to pursue. In essence, service users said they recognise the efforts being made to involved them in meaningful 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 13 activities, but that they did not always wish to take part. They however, enjoy joining in some of what goes on at Eden Place (the core unit) such as coffee mornings. Service users cited visits to the Spa Centre, Museum and Library and Brunswick Healthy Living Centre as some of the opportunities they have had for occupation and leisure. Visiting arrangements at the Home remain flexible so as to encourage service users’ family and friends to visit and for those whose relatives live some distance away and are not able to visit regularly, support is given for them to maintain links by letter and telephone. No restrictions were observed or reported in regard to service users choosing whom they wish to see and when. Indeed one service user had a friend who was visiting during part of the inspection. It was noted that the service users’ telephone had, as required at the last inspection, been moved from the sitting room to somewhere that offers more privacy to make and receive calls. Nothing was observed or reported on this occasion that detracts from the service users choice, freedom and responsibilities as observed at the last inspection visit. Service users each have their own bedrooms, which they are able to lock and which are out of bounds to others without the permission of the occupant. Similarly, service users mail is regarded as their property and is given to them unopened, but they can ask for staff’s assistance to understand and respond to official correspondence. It was observed that the Home is arranged so that service users have access to all areas registered for their use and that informality is preferred in how service users and staff address each other, i.e., they use first name terms thus dispensing of any artificial barriers. Staff members were seen to interact with service users all the time and include them in discussion except when dealing with their personal details. Service users accordingly behave in ways that suggest that they feel that it is their home. For example, on arrival one service user recognising the inspector, invited him in and extended the usual polite welcome and hospitality. As was reported at the last inspection, care is taken to find out the foods that service users prefer and the menus are planned accordingly. The record of food provided shows what each service user has had to eat on each occasion and that they are offered choice. Three meals are provided each day one of which is a hot meal, but service users are able to help themselves to drinks and snacks, e.g., fresh fruit, which is also readily available. The overall assessment of the catering arrangements is that they are acceptable. That is to say, the diet is wholesome and reasonably varied though sandwiches feature often on the menu for the evening meal. It is suggested that service users be consulted with ideas for adding more variety to the evening meal, particularly in colder weather when a hot meal might be preferred. 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 14 Taking account of how often grocery shopping is done, the quantity of food seen in store was ample and commensurate with the proposed menus. This suggests that those responsible for the Home ensure that there is enough food for service users. 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Service users are benefiting from care and support that addresses their personal care health needs in ways that reflect their individual circumstances and which promote their privacy, dignity and independence. EVIDENCE: At the time of inspection all of those resident at the Home were able to attend their own personal and intimate care. So they are able to choose their own clothes and conduct, with some supervision and support where necessary, all their activities in daily living. Staff are aware of the need to monitor service users condition and refer them for specialist assessment so that where they might need technical aids or equipment to assist, say, their mobility this can be provided. Examination of service users records showed that they are all registered with GPs from whom they receive an acceptable service. All the service users continue to receive ongoing specialist services for their physical and mental health including review of their medication. Similar arrangements have been made for service users’ dental, optical and foot care. The Manager reported that there has been no cause for any of the service users to be referred for any accident or emergency treatment since the last inspection. Service users themselves told the inspector that they are currently in good health and from 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 16 the inspector’s own observations and understanding of their existing health condition, this appeared to be the case. At the last inspection, the arrangements for the storage, administration and the disposal of discontinued or unused medication was judged largely satisfactory. Since then, work has been done to ensure that where service users keep and administer their own medication, there is a clear label on the container stating what the medication is and the prescribed instructions. The inspector saw such a labelled container and agreed with the Manager that the label needs to be typed and laminated so as to prevent the fading seen in the example that was examined. It was also noted that a secure cabinet has been installed in all the bedrooms so that where service users are assessed as being able to keep and administer their own medication, they have somewhere secure to keep it. These measures address the deficits previously identified and the Home is now assessed as meeting the required standards in full. 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Acceptable steps have been taken to ensure that service users are assured that they may express views and any concerns that they have, which will be listened to and taken seriously. Service users are also likely to remain safe in the Home protected by the measures in place to ensure that they do not suffer any abuse, neglect or other forms of ill treatment. EVIDENCE: At the last inspection the Home was assessed as complying with the standards laid down for the protection of service users. Its performance against those standards was also assessed on this occasion and once again it was deemed to be doing what is required. That is there was evidence of a clear procedure for complaints, which is prominently displayed in a communal area and readily accessible to residents. Set out in easy steps, the complaints procedure makes clear to whom the service user may wish to complain. The staff members are genuine in working to ensure that service users are content and would feel comfortable in taking views or concerns to them in the first instance. However, so as to guarantee that, in addition to the Commission, service users have access to a number of independent sources, they are provided with the details of the local advocacy service. One service user said that if he was concerned about anything he would feel comfortable to talk to the staff or to the Manager who visits and spends time in the Home daily. The record of the most recently appointed member of staff was checked and showed that care is still being taken to ensure that those employed to work at the Home are fit to do so and do not pose any risk to service users. The Home’s whistle blowing policy together with its adult protection procedure was 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 18 also judged an effective safeguard for service users against any risk of abuse or unfavourable treatment in the Home. It was noted that a recommendation advanced at the last inspection for the Home’s vulnerable adult protection procedure to be checked for alignment with local multi agency procedures has not been addressed. It is imperative that this is done and that staff members become familiar with the local multi agency procedures and have easy access to a copy of them in the Home. 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Service users in this Home are living in a warm, comfortable and homely environment, which, save for a few details that need attention, make it fit for its purpose. It is being maintained in clean and hygienic condition. EVIDENCE: Although the Home is warm, homely and comfortable for the current residents, it has to be recognised this will only remain the case while they remain active and have minimum personal care needs. This is because it is a relatively small house where all the bedrooms are on the first floor and the only bathroom, which houses the only toilet is on the ground floor. The Home’s facilities would therefore not be suitable for those with significant physical disabilities or in need of a high level of personal care. The Home predates the introduction of the National Minimum Standards and therefore some room sizes though satisfactory and acceptable to the current residents, are small. At the last inspection the small bedroom, which also housed the boiler was experienced as uncomfortably warm causing the occupant to have to keep the window open at all times when the boiler was in operation. Encouragingly, the boiler has now been relocated from this room, the window in this room, which needed repairs has been replaced and all that is left to be done is the construction of wardrobe space to replace the previous 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 20 boiler housing. The occupant of this room said he was pleased with the work, which has been done so far and gave his opinion on how the rest of the work should be completed. Acting on requirements made at the last inspection, the Manager has addressed a number of other issues in regard to repairs and maintenance. These include the replacement of floor covering in the kitchen and bathroom, eradication of the unpleasant odour in one of the rooms and installation of a new washer/drying machine, has overcome the problem of drying laundry when it is not possible to hang them out to dry. This has all contributed to the comfort and homeliness which was seen and which service users said they were experiencing at the time of inspection. As acknowledged by the Manager and a service user who was present, the seating in the living room is now in poor condition and needs to be replaced. The service user advised that being dark and with large patterns, the carpet in both the living and dining areas is aesthetically displeasing and should be replaced at the same time as the seating so as to create a lighter and more coordinated appearance. Whilst the carpet to which the service user referred is in reasonable condition, the inspector nevertheless concurs with the service user’s observation about its appearance and would recommend that due regard is given to the service user’s view in this connection. It is also recommended that the gas fire which was removed from the dining room is replaced by another fire (gas or electric) so that in the event of the central heating system failing there is a back-up source of heating in the communal area. The Home is maintained in clean condition throughout and there was evidence that staff members have received training in health and safety and reflect this in their practice. For example there is a health and safety policy, staff members have had training in Food Hygiene and were observed to be meticulous in washing their hands particularly when preparing food. Currently there is no cause for soiled laundry to be dealt with on the premises or for clinical waste arrangements to be made. These steps are proving effective as there has been no report of any outbreak of infection in the Home. 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 35 Service users are being cared for by staff of good character who have the personal attributes and basic training necessary to respond appropriately to each service user’s needs. There is, however, scope for a planned ongoing staff training and development strategy. EVIDENCE: As earlier mentioned, this home is an annex to a core unit (a nursing home) accommodating those with more intensive care and treatment needs. Service users in the Home are served by two exclusive staff members, but where necessary, they also have access to the collective competencies and skills of those in the nursing home. These include qualified psychiatric nurses, which means that where required, service users have access to professionally qualified staff who are able to assess their emotional and physical health needs and arrange appropriate responses. Service users were seen to relate naturally to staff who in their approach appeared committed to the service users and the principles on which the Home is run. In the situations where staff were observed interacting with service users they treated them like adults – listening to their views, guiding and supporting, but without condescension or imposing their own views. The situations outlined earlier where a service user joined the inspector and the 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 22 Manager in discussions about the maintenance of aspects of the premises typically illustrate this observation. All staff members, including those who work exclusively in the Home, have received a programme of induction and basic training to fit them to work competently and safely with service users. This training has included Health and Safety, First Aid, Food Hygiene and the occupation and recreation of service users. As required 50 of those who are employed to work exclusively with the service users hold a National Vocational Qualification Level 2 or 3 in care. What is absent in relation to staff training and development is a training and development plan linked to the Home’s service aims and service users needs. For example, each member of staff should, taking account of the Home’s overall annual staff training and development strategy, have an individual training profile with a plan for their priority training for the year. In light of the Home’s service aims and service users needs, priority training in assessment and care management and techniques in rehabilitation and recovery are indicated. 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Service users are benefiting from this well run home, which has been positively affected by the skills and commitment of the current manager, whose mission is to place the needs, views, wishes and feelings of service users at the heart of the Home’s day-to-day operation. Further, though service users are being cared for in an environment, which seeks to promote their independence and recovery, this is being done within a system that takes proper account of the need to take reasonable precautions to ensure their health, safety and welfare. EVIDENCE: At the time of the last inspection the Manager had only recently been appointed and since then, as this report shows, has got to grips with all the outstanding issues and is dealing with them in a planned way. The Manager who is a qualified nurse was previously employed at the Home, as deputy manager so was familiar with the way it is run and the service users circumstances and needs. Since the last inspection, the Manager has commenced an accreditation programme leading to the required National Vocational Qualification level 4 and has also applied for approval to become the Registered Manager of the Home. 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 24 The Manager is aware of his responsibilities to ensure that the Home is run in accordance with its Statement of Purpose, the relevant national minimum standards and regulations, and its contractual obligations to service users. There are some systems in place for monitoring and assuring quality of care in the Home, but these need to be developed, aligned and brought together in a more systematic way to represent an overall quality assurance system. Currently the quality of care is monitored by the Manager ‘walking the job’ and seeking views and comments directly from service users on a day-to-day basis. Service users and stakeholder (GPs, Psychiatrists and others with and interest in service users and the home) questionnaires have been designed and administered, and the observations and findings of the Commission’s inspection reports, which are made available to staff and service users are used in the quality assurance process. As mentioned earlier, the Manager reported that he had cause to be doubtful about the data from the service user and stakeholder surveys and therefore has delayed review and report on the quality of care as required by regulation 24. In order to show clearly that the Home’s quality assurance system is operating effectively, a way must be found to co-ordinate monitoring activities such as inspection reports, the complaints register, service users meetings, visits conducted under regulation 26 and customer/stakeholder satisfaction surveys. The data from these sources together with the planned objectives and outcomes for service users individual care, might then be used to inform the review of the quality of care and the annual development plan specified in standard 39.2. Something along these lines must be done in order for the Home to meet standard 39 in full. It will also be necessary for the reports of visits conducted by or on behalf of the Registered Provider in fulfilment of regulation 26, to be submitted to the Commission as required. Staff have received induction and in-service training in a wide range of health and safety topics, i.e., First Aid, Lifting and Handling, Food Hygiene, etc. This equips them to support service users’ physical care needs and to keep them safe. Additionally, there is a portfolio of documents related to risk assessments, policies, procedures and guidance addressing both generally and specifically the requirements set out in quality indicators in standards 42.3 and 43.4. These specify what those in charge of the Home must do in relation to safety matters such as the central heating boiler maintenance, precaution against water borne diseases such as Legionella and compliance with the various health and safety legislation that apply to workplaces. The accident record was not checked but the manger reported that there has been none since the last inspection. It was observed that most of the fire precaution measures recommended by the Fire Service are being taken, as required. That is, there is an up-to-date fire risk assessment and the records revealed that alarm system test were 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 25 being carried out at the recommended weekly intervals until 28/10/05, which means that approximately three weeks has elapsed without one being done. The fire procedure specifies that at least three fire drills should be conducted each year but the record shows only one being done since 10/01/05. The Manager believes that all the fire alarm tests and drills have been carried out, but there are gaps because some events were simply not recorded. Evidence of other safety measures such as checks and servicing of the central heating boiler, gas and portable electric appliances was also available in the records. 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x 3 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 x 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 x x 2 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 9 Manor Road Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 X X 2 x DS0000004480.V270661.R01.S.doc Version 5.0 Page 27 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 YA23 Regulation 13 (6) Requirement The Manager must ensure that the Home’s vulnerable adult procedure accords with the local multi-agency procedures, that staff have a working knowledge of these and a copy is easily accessible to them for reference. Make good the cupboard in the service user’s bedroom from which the boiler was removed and conceal the exposed pipes, which remain. In carrying out this work due regard must be given to the occupant’s views. Replace the excessively worn seating in the service users’ sitting room. Ensure that there is a training and development profile for each member of staff and that this reflects ongoing in-service training in relation to the aims of the Home and service users’ needs. Develop a co-ordinated quality monitoring/quality assurance system for the Home and submit to the Commission reports relating to the outcome of service user/stakeholder DS0000004480.V270661.R01.S.doc Timescale for action 31/03/06 2 YA24 23 (2) 25/02/06 3 4 YA24 YA35 16 (c) 18 (c) 25/02/06 31/03/06 5 YA39 24 and 26 31/03/06 9 Manor Road Version 5.0 Page 28 6 YA42 23 (4) surveys, visits conducted in accordance with regulation 26 and review of the quality of care, which should form part of such a system. Ensure that all the routine fire precaution tests are carried out at the frequencies specified by the Fire Service and in the Home’s fire prevention policy. Those checked must be recorded contemporaneously. 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA17 YA20 Good Practice Recommendations In consultation with service users, seek to introduce more variety in the food provided for the evening meal. Proceed as agreed with ensuring that the container of any medication kept in service users’ possession has a typed and laminated label with the name of the medication and the prescribed instructions. Take account of service users’ views about the appearance of the carpet in the sitting and dining areas and consider reinstalling either a gas or electric fire in the dining area to serve as an alternative source of heating should the central heating system fail. Organise the assessment, individual plans, recording of care inputs and outcomes such, that as a process, it shows clearly the ‘year on year’ development for each service user as specified in standard 39.5. 3 YA24 4 YA39 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 9 Manor Road DS0000004480.V270661.R01.S.doc Version 5.0 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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