Inspection on 06/05/05 for 9 Manor Road

This inspection was carried out on 6th May 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

9 Manor Road 21/08/08

9 Manor Road 23/08/06

9 Manor Road 21/11/05

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 06 May 2005 09:00 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 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 Stationary 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 E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 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 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 A manager has been appointed, but not yet registered CRH Care Home 3 Category(ies) of MD - Mental Disorder 3 registration, with number of places 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28 February 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 to the rear of the kitchen. The house 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 E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out between 10am and 6pm and took account of the previous inspection report. In addition, the manager and two other members of staff were interviewed. Service users were interviewed informally and account has also been taken of what they had to say. What the service does well: What has improved since the last inspection? 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 E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 7 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 standard(s) 1, 2, 3, 4 and 5 The inspector is satisfied that existing service users were not only involved in the decision to become permanent residents, they did so on an informed basis. Furthermore, this is most likely to be the basis on which future residents will be admitted. There was some evidence to suggest that service users needs and aspirations are being assessed, but the way this happens is by chance. Given the residents’ needs and circumstances are likely to change over time, it will be necessary for periodic formal assessment to be conducted to inform the care planning process, which should put into action the measures to address any needs and aspirations identified by the assessment. The inspector was satisfied that when necessary specialist assessment such as medical assessments are conducted and the service user and staff are made aware of their outcomes. Apart from the lack of up-to date general assessment of residents’ needs, staff members are provided with sufficient information, for them to meet residents’ basic needs. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 8 EVIDENCE: Currently all three persons resident at the Home, were transferred to it from the main establishment, which is a nursing home in close proximity. The residents’ accounts when they were interviewed indicate that they were all familiar with the Home before their transfer. They had visited the home before moving in and were positive about their transfer. Further evidence was provided in the form of accounts, which the manager and staff gave and corroborated by documentary evidence such as that found in service users records and the Home’s admission and discharge policies and procedures. Records such as residents’ care plans and daily notes of their circumstances, the Home care inputs and their impact on residents, when taken together show that there is some ongoing assessment activity. There was, however, no record of current formal assessments to demonstrate that residents needs and aspirations have been established, and since the manager reported that the original assessments, which are now somewhat out of date, have been archived there is no sound basis for informing the current care planning process in individual cases. There was evidence in residents’ records to show that when necessary, specialist assessment, e.g., medical assessment, and review are arranged and that these processes yield sufficient information to enable staff to discharge the caring duties to residents. Evidence was provided, at inspection, of two contracts or agreements. One is the contract in which the home enters with the authority responsible for the resident’s care and another, which is less detailed, with service users. For example, the Residents Agreement is limited to outlining the Homes rules and what is expected of the resident in this regard, but omits crucial information such as the scale of charges. The contents of those two agreements are acceptable, but they need to be combined in the one that is intended for residents. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 6, 7, 8 and 9 Although, as earlier pointed out, there was no evidence of current comprehensive assessments, residents were deemed nevertheless aware of their circumstances and what is done to fulfil their requirements. Although residents are admitted to the Home on the understanding that they are capable of living largely independently, the absence of the original and any current comprehensive assessment of their circumstances means that it is not possible to judge, accurately, whether there are any risks in the way their care is arranged. With this in mind, some form of risk assessment is necessary to find out if living so independently, as they do, places them at any risk to themselves or others. This would add the certainty that their current care and support needs currently lack. There was no evidence of curtailment of residents’ choice of reasonable activities or failure to enable them to take responsible risks. Further, the Home is run so that residents are able to make decisions about their own lives. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 10 EVIDENCE: Evidence was seen among residents’ records to show that where their circumstances so dictate, they are assessed externally by specialists and any treatment regimen prescribed is included in their care plans. The manager reported that he is not satisfied that current assessment format, which would be used to assess residents either at the commencement of their stay or periodically thereafter is appropriate for the purpose for which it is intended. In light of this, the manager advised that work is being done to improve this format so that it will include consideration of the resident’s life-style and personal aspirations. The manager reported that residents are enabled to make decisions about all aspects of their lives, but are supported and guided in areas where they are deemed to be vulnerable or where risks have been identified. Accordingly, residents are in control of their personal finances and other aspects of their lives as befit their adult status. Details of local advocacy agencies were observed to be available in the Home in a location which is immediately accessible to service users. Residents related to the inspector some of their experiences of the Home such as its daily routine, how day-to-day domestic activities are organised. That is, they choose when to get up and retire to bed, how they organise their breakfast and how frequently shopping and cleaning are done. These routine activities and any difficulties, which arise, are discussed in a meeting of residents and staff, which is held every two weeks. A dossier was presented, the contents of which included fieldwork data and analysis of work, which has been done to elicit the residents and other relevant persons views about the running of the Home. This was intended to provide further proof of the Home’s attempts to find what residents and other relevant people think about the way the home is run and the quality of service that it provides. In relation to whether residents “are supported to take risk as part of an independent lifestyle”, these was no evidence of any documented individual risk assessments of this. Equally, however, there was evidence of residents enjoying a life-style in which they are at liberty to establish their own routine, pursue their own interests both within and outside the Home. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12, 13, 15, 16 and 17 It was considered that there is no prohibition on residents being able to pursue any legitimate activities in which they were engaged prior to entering the Home. Indeed, this is actively encouraged. The range of occupant and leisure activities in which they were engaged was deemed somewhat limited. This is not considered to be the result of any restrictive practices at the Home. It is seemed more likely to be as a consequence of some residents’ lack of confidence. Accordingly, it was encouraging to learn that this is recognised by the manager and staff who outlined a sound approach, which they intend to adopt to address this issue. No unreasonable restrictions are placed on residents maintaining contact with their families and their friends. Indeed, this is genuinely encouraged. However, unless residents use their bedrooms to receive their visitors, it is considered that they would be little scope for them to do so in private elsewhere in the Home. This also applies to the telephone, which is made available for residents’ use but is placed in an area where it is not possible for residents to make and receive calls in private. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 12 Being configured as it currently is, it does not appear technically feasible to carry out modifications to the building as would be necessary to address the issue of providing satisfactory facilities, which might contribute to residents establishing and maintaining a full range of relationships. It is considered that this should nevertheless feature in future development plans for the Home. Nothing in the Home’s policies, procedures and practices was considered to be contrary to the promotion and safeguard of residents’ independence, choice and freedom. Care is taken to establish residents’ food preferences and to establish a mealtime ritual in keeping with their requirements. Provisions are made for service users to have at least three meals per day – one of which is hot – as required. Further, stores of food, which were seen and the reported frequency at which grocery shopping is done is satisfactory. The menus, which also serve as the record of meals provided, were deemed insufficiently detailed as to provide enough information to enable a proper assessment of residents’ diet. EVIDENCE: Those currently resident at the Home comprise both male and female, share a common culture and have no communication difficulties. The Home is in the heart of a residential area of a district community and as previously stated residents are at liberty to pursue their own interests. In this connection, some residents reported that they use local facilities such as shops and public houses and have friends outside the Home. The manager reported that residents are registered to vote and are encouraged to exercise this right. It was observed that in-house entertainment such as radio and television are provided for residents’ use. In demonstrating individual interests, it was noted that a resident opted to stay awake throughout the night to watch television commentary of the general election results, which were being announced on the day of inspection. It was observed that none of the residents are engaged in employment, education or voluntary work. The manager reported that though residents are free to choose whether they engage in activities, it is recognised that the support that they need to avail themselves of opportunities to do so is currently insufficient. With this in mind, an additional support worker has been appointed with the intension of enabling residents, if they wish, to pursue a wider range of activities. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 13 During the inspection a resident was observed to receive a visitor and the written visiting policy was produced for examination. This was satisfactory and together with what was observed confirms are enabled to maintain contact with others. The inspector saw a meal being prepared. Residents stated that the quality of food is good. Residents are able to access food supplies and there is a variety of fresh fruit. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 14 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 standard(s) 18, 19, 20 and 21 The whole ethos of the Home is one in which residents are in charge of their own lives but are given support and assistance by staff when required. Staff were considered to have a good grasp of residents’ physical and emotional health requirements and were responding to these adequately. Where appropriate, residents were being enabled to administer their own medication, but, as highlighted at the last inspection, some improvements are required to ensure that this is entirely safe. The inspector also considered that the health issues of particular residents, as cited in the last inspection, were being tended. The approach, which the manager reported as being taken to try to establish residents’ wishes in the event of sickness or other circumstances where they might not be able to make them known, was considered to be good practice. EVIDENCE: Documents seen among service users individual records – reports, letters and notes – reveal that where there is cause, and as an outcome of routine monitoring, residents’ physical and emotional health care needs are properly assessed by suitably qualified health care professionals. There was also evidence of home care strategies for responding to such needs. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 15 All service users are registered with GP practices, from which the manager believes they receive a good service. Similar arrangements have been made for residents’ dental and optical care. None of the residents have been referred to any accident and emergency treatment since the last inspection and nothing in the records revealed that they have conditions, which might be attributable to neglect. Those currently resident at the Home are able to attend their own personal care, but there are systems and practices in place to provide support of this in ways that would take proper account of the individual’s wishes and feelings. It was observed that, subject to certain safeguards such as only being permitted to keep a week’s supply of medication at any given time, some residents administer their own medication. The manager advised that lockable storage is provided for the bulk of residents’ medication. This is located in the nursing home and responsibility for the implementation of the policy and procedure for the storage, administration and disposal is overseen by a qualified nurse. The manager reported that work is being done (opportunistically) to establish residents’ personal wishes for events where they might not be in a position to make their wishes known. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 16 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 standard(s) 22 and 23 There was ample evidence to suggest that if or when residents have any complaints or concerns these would be taken seriously. Similarly, it was deemed that proper steps were being taken to protect residents from abuse in terms of the Home’s staff recruitment and selection procedure, its whistle blowing policy and its preparedness to be open to independent scrutiny. The inspector nevertheless considered that these measures are likely to be strengthened if they were to be reconciled with the local adult protection procedures. EVIDENCE: As required, there is, in the Home, evidence of a clear procedure for complaints, which is prominently displayed and readily accessible to residents. The Manager reported that he is keen for residents to not only feel comfortable in taking their concerns to staff, but also to have access to independent advocacy and in this connection has sought to establish links with a local advocacy scheme. Staff records showed that careful steps are taken to ensure that those employed to work at the Home are fit to do so and the Manager reported that there has been no cause to refer any staff member for inclusion in the POVA register. There is a whistle blowing policy, which is linked to the Home’s adult protection procedure, but there was no evidence of the local adult protection procedure. Since the manager reported that no complaints have been made since the last inspection, the complaints register was not examined on this occasion. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 17 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 standard(s) 24, 25, 26., 27, 28,29 and 30 In the inspector’s judgement, the deficits relating to the Home’s environment, as detailed in the evidence below is in large part due to it being registered before the introduction of the current national minimum standards, but was originally registered because at that time it provided a safe, well-maintained and accessible facility for its minimally dependent residents. That said, the premises is deemed indistinguishable from those in the neighbourhood and is equipped to provide the homely ambience and the facilities, including those for communal use, which are set out in the Statement of Purpose. One bedroom, which was not measured on this occasion, appeared particularly small and was uncomfortably warm. Another has a window which appears to have had repairs, but is deteriorating and is close to the vent for the central heating boiler and needs to be replaced. Bathing and toilet facilities in the Home are deemed to be inadequate because there is only one bathroom, which is on the ground floor and provides the only toilet. This means that if one resident is having a bath and another needs to use the toilet, this would not be possible. It also means that when residents wish to bathe, they have to go through the communal areas to access the bathroom, which might present a compromise of privacy, particularly as the home accommodates both male and female residents. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 18 Should residents become ill or temporarily incapacitated, the location of the bathroom might prove inconvenient because they might not be fit enough to travel the distance from their bedrooms on the first floor to use this facility. Apart from this and defective floor covering, the bathroom is otherwise properly equipped, including an appropriate aid for the needs of a particular service user. The Home is maintained in clean condition, but since the washing machine, the Home’s only laundry facility is installed in the kitchen, it will be necessary for a risk assessment to be conducted to find out whether this poses a hygiene hazard. For example, if at any time it becomes necessary to deal with soiled laundry. There is no facility in the Home for staff to store their personal belongings and should it be necessary for them to be on duty throughout the night, this would have to be on a waking duty basis, as there is also no staff sleep-in facility. EVIDENCE: The building is maintained in largely sound condition and is presented in reasonable decorative order. Furniture and fittings and beds and bedding were equally acceptable. In its current configuration, the home provides three bedrooms on the first floor, two of which are under the usual 12m2 requirement, but pre-date the current minimum standards and this is reflected in the Statement of Purpose. The bedrooms are individual in the way they are decorated, have locks on the doors and are equipped in accordance with Standard 26.2, except for instances where residents have signed a declaration indicating that they do not wish to have certain items of furniture and facilities such as Television aerial or telephone points. One bedroom, the smallest, houses the boiler and the temperature outside being quite warm on the day of inspection this room was uncomfortably warm. The occupant confirmed that it is usually as warm and the window has to be left open and a portable fan used to improve the ventilation. This is not an acceptable situation and needs an appropriate remedy. The exterior of the window frame in the bedroom nearest the central heating boiler vent appears to have been repaired on a few occasions. However, it is beginning to deteriorate and needs to be repaired or replaced. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 19 The other window frames throughout the house are currently intact, but consideration might be given to replacing them with a type that requires less maintenance. A sitting and dining area has been created by the removal of a wall between what appears to have been two reception rooms. There was evidence that the condemned gas fire had been removed from the dining area. The opening left by this needs to be filled either by replacing the fire or my some other appropriate means. The kitchen, which is equipped with all the necessary facilities, is adjacent to the dining room and, in keeping with the homely ethos, accommodates the washing machine. The only bathroom, in which there is the sole toilet, is located on the ground floor beyond the kitchen. It is equipped with bath, washbasin, toilet and a hoist. The floor covering in this room appeared worn, had come adrift from the skirting boards and sanitary ware and emitted an unpleasant odour. This needs to be replaced and any other necessary remedial work is carried out. It was observed that there are no facilities for staff to sleep-in on the premises should this be necessary or for storing their personal belongings. Indeed, there is a general lack of storage for items such as the ironing board and clothes airer. The home operates a no smoking policy thus any resident who wishes to smoke has to do so outside. There is a good-sized rear garden, but it had no garden furniture, is mostly paved and has only a few plants. Making this facility more interesting and providing garden furniture is likely to enhance it us facility for residents 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35 and 36 Residents are protected by measures, which are taken for safe selection of staff members who are employed at the Home. Furthermore, given that residents admitted to the Home are minimally dependent, it is considered that the staff members are provided with adequate training to do their job. Although residents are admitted to the Home on the understanding that they are they are minimally dependent and there are, therefore, lengthy periods when there are no staff roster for duty, this situation is deemed risky. The usual staff supervision and support arrangements are adequate to enable them to undertake their tasks. EVIDENCE: Examination of staff records provided evidence of staff completing an application form, which requires them to give details to corroborate their identity, qualifications and work history. It was also observed that references are taken up and Criminal Records Bureau checks are made. Among the information made available for inspection and which the manager reported is given to staff, is a clear job description, contract and whistle blowing policy and the Home’s Statement of Purpose. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 21 Currently only one member of staff is employed to work exclusively in the Home for eight hours per week and, until recently, this post was designated as Housekeeper. In recognition of the need to provide residents with more support to engage in a wider range of leisure and, perhaps, vocational activities, this post has been re-designated Support Worker and another similar post has been created yielding an additional 12 hours per week. An appointment has been made to the second post, which the post holder is due to take up imminently. This person is already in the employ of the registered person and is reported to have recently completed NVQ level 2. The records show that the existing member of staff has received in-service training in Food Hygiene, Manual Handling, First Aid, Basic Health and Safety and in Infection Control. Effectively there are no staff members on duty in the Home during the evening and throughout the night. Furthermore, there is no contingency plan for staffing it at those times when circumstances might dictate that this should be the case. When residents were asked what they would do in an emergency, (i.e., sudden illness, fire, etc) they said they would telephone Eden Place, the nursing home and core unit. In the event of their needing to do this, as understood, the nursing home does not roster additional staff for the purpose of responding to the staffing requirements of the Home. This would, potentially, place residents in both homes at risk. The manager, who reported being professionally qualified, is responsible for the staff’s supervision. The staff supervision records to show that there are established staff supervision arrangements. It was, however, noted that the last recorded supervision was in January 2005, but the gap was explained by the current manager’s need to reschedule some tasks so as to deal with priorities following the previous manager’s resignation. In addition to the formal supervision arrangements, the manager reported that he visits the Home on a daily basis when any necessary staff briefings and information exchange are conducted and on-task supervision is carried out. Although there were no records of formal annual appraisal of staff’s performance, the manager indicated that this was being done and in part informed the decision to re-designate the existing member of staff’s job title. Annexed to the Statement of Purpose is a portfolio of policies, procedures and guidance to assist staff in the effective discharge of their duties. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 22 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39 and 42 Because person who manages the Home is not registered to do so, the registered person must therefore act to ensure that the post holder fulfils the criteria for registration and seek to be registered forthwith. It is considered that the Statement of Purpose makes clear the Home’s aims and objectives and the principles and methods for achieving them. These are understood by the manager and staff who, in their report about the general running of the Home and in explaining residents’ specific requirements demonstrated their understanding of what the Home sets out to achieve. They were also able to demonstrate that they can adjust working practices and, as necessary, manipulate the Home’s environment in light of residents’ changing needs. The promotion of the Home’s complaints procedure, advocacy arrangements and general openness by both manager and staff during the conduct of this inspection leads to the reasonable belief that, in combination, this is a strategy that permits residents and staff to express any concerns they might have. Furthermore, that such concerns will be taken seriously. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 23 The registered person is mindful of requirements to have effective quality assurance and planning systems in place, which are able to demonstrate effective developments both in the overall management of the Home and in residents’ care. In practice some attempt has been made to fulfil those requirements, but not as robustly as the standards dictate. Residents were familiar with the inspection process and the latest inspection report accessible to them. From this it was inferred that they are informed about Commission’s functions in respect of the Home. The manager was receptive to critical observations about some of the policies and procedures and, in advancing some of his own ideas for change demonstrated an understanding of the requirement to keep such policies, procedures and practices under review. The registered person did not appear to have an effective system for ensuring a timely response to requirements in reports of inspections carried out by the Commission. EVIDENCE: Following the previous manager ceasing to be employed at the Home since earlier this year, a new manager has been appointed, but has not yet been registered to act in this capacity by the Commission. In relation to the standard, which requires that the Home be run in a manner that creates “an open, positive and inclusive atmosphere”, evidence was provided in the form of the complaints procedure, which is readily available and understood by residents. There are also arrangements for residents to have access to external advocacy and what the inspector observed as a genuine openness between residents and staff in the way the Home is operated day to day. Whilst there is evident leadership and staff roles being clearly defined, there is no perception of exclusive hierarchies. Indeed residents appeared to be entirely at ease with each other and with staff. At inspection, staff unhesitatingly discussed aspects of the general running of the Home in residents presence and residents in their accounts were knowledgeable about most aspects of how the Home operates. None of the residents appeared to be excluded. It was reported that the Home embraces equal opportunities in principle and nothing was observed or reported to suggest that this is not applied in deeds. The manager presented a folder with the raw data of a residents and stakeholders survey, which was conducted some time ago. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 24 Some of the data has been analysed and reflects positively respondents’ experience of the service. It was observed, and the manager confirmed, that the requirements advanced at the previous inspection had not been addressed. The manager explained that this was due to the previous manager’s failure to act upon them. 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 residents physical care needs. Additionally, a portfolio of documents was presented, which related to risk assessments, policies, procedures and guidance relating generally and specifically to the requirements set out in quality indicators 42.2, 42.3 and 42.4. The accident record was checked but did not reveal any remarkable incidents since the previous inspection. The manager also reported that there has been no cause to seek accident and emergency treatment for any resident since then. It was observed that fire precaution measures are being taken, as required. That is, there is an up-to-date fire risk assessment and the records revealed that alarm system, smoke detector and heat seeking checks are being carried out. There were current records of fire drills and certificate of maintenance of fire alarm, fire fighting equipment and emergency lighting. 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. Although Standard 43 was not formally assessed, it was noted that displayed in the Home is a current certificate of insurance covering public liability, treatment or malpractice and employment liability. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 25 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 3 2 3 3 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 3 2 3 3 2 3 2 Standard No 31 32 33 34 35 36 Score x x 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 9 Manor Road Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 2 3 2 x x 2 x E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 26 Yes 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 2 Regulation 14 (2) Requirement Timescale for action 16/09/05 2. 5 5(1)(c) and 5 (3) 3. 9 13 (6) 4. 12 16 (2)(m)(n) The registered person must conduct periodic assessment of each residents circumstances to establish any change in their needs and aspirations. The outcome of the assessment, which must clearly reflect the residents wishes and feelings should inform the care plan. Develop the Resident Agreement 16/09/05 or contract so that it sets out the full scale of charges and what they include and exclude. This must be in addition to the other information, which is included in the current agreement such as the terms and conditions of accommodation and care and the expectations on both parties. Conduct individual risk 29/07/05 assessments of residents to ascertain whether they may pose a danger to themselves or other or in which circumstances they might be most vulnerable. This replaces Requirement 2 of the previous report, which timescale for action was 30/04/04. Proceed, as intended, with the 9/07/05 plan to encourage and support residents to become engaged in Version 1.30 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Page 27 5. 15 12 (4)(a) 6. 17 16 (2)(i) 7. 20 13 (2) 8. 24 23 (2)(p) 9. 24 23 a wider range of leisure and/or vocational activities. This replaces Requirements 3 and 4 of the previous report, which timescale for action was 30/04/04. The registered person must in future development plans:i) arrange for facilities to be made available so that residents have the opportunity to meet with others in private without having to use their bedrooms; and, ii) resite the telephone so residents may make and receive calls in private. A development plan to this effect must be submitted to the Commission. The registered person must ensure that the menus, or otherwise the record of meals provided, detail all the meals which have been prepared and/or served such that a proper assessment can be made of whether residents are receiving a wholesome diet. This supersedes Requirement 5 of the previous report when the timescale for action was 15/04/05 In instances where residents administer their own medication, proceed, as agreed, with labelling the individual medication container with the description of the particular medication. This replaces Requirement 10 of the previous report, which timescale for action was 30/03/05 The registered person must arrange for the central heating boiler to be relocated to a site within the Home where it will not cause any hazard or discomfort to residents. The registered person must replace the floor covering in the 2/09/05 17/06/05 13/06/05 16/9/05 26/08/05 Page 28 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 10. 24 23 11. 24 23 12. 30 13 (3) 13. 33 18 (1)(a) bathroom and ensure that all areas of the Home are free of offensive odours. This replaces Requirement 12 of the previous report, which timescale for action was 30/04/05. The registered person must replace the window on the first floor nearest the vent from the central heating boiler. This replaces Requirement 15 of the previous report, which timescale for action was 31/01/05. The registered person must replace the gas fire, which has been removed from the dining area, with a safe and suitable substitute or make good the void created by the removal of the fire. The registered person must conduct a risk assessment and introduce such control measures as might be indicated in relation to any hygiene risk, which might arise from the location of the washing machine in the kitchen and there being no other laundry facility on the premises. The registered person must conduct a risk assessment in relation to there being no staff on duty at the Home for substantial periods of time, including night time. The risk assessment must consider the circumstances in which it might be predicted that it is necessary to have staff on duty in the Home at all times and the feasibility of any contingency plans for such events particularly in emergencies and at short notice. The registered person must take such actions as the risk assessment indicates is necessary and retain a copy of the risk assessment report at the 02/09/05 26/08/05 27/06/05 17/6/05 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 29 Home for inspection. 14. 37 9 The registered person must ensure that the person appointed to manage the Home fulfils the criteria for registration and become so registered in the timescale specified. The registered person must complete the analysis of the residents and stakeholders survey and prepare a report of the result and how this will contribute to service development and quality. Once completed the report must be promoted to residents and a copy submitted to the Commission. The Pegistered Person must ensure the shopping and cooking skills of each service user are assessed and, given that the services of the home are designed for almost independent service users, develop an individual action plan with timescales to facilitate service users in gaining these skills. This is Requirement 6 from the previous report, which timescale for action was 30/04/05. The Registered Person must ensure service users have a lockable draw or cupboard for the storage of their medicines. This unmet Requirement 11 of the previous report, which timescale for action was 30/03/05. The Registered Person must provide adequate laundry drying facilities other than clothes airers and drying on radiators. This is Requirement 14 of the previous report, which timescale for action was 30/04/05 has not been fulfilled. E53 S4480 9 Manor Road V226715 060505 Stage 4.doc 09/09/05 or by negotiation with the Commissn 23/9/05 15. 39 24 16. 12 17 31/7/05 17. 13 20 17/06/05 18. 16 24 17/06/05 9 Manor Road Version 1.30 Page 30 19. 13 42 20. 13 42 The Registered Person must ensure that guards are fitted to the central heating radiators. (previous timescale of 28/2/04 not met.) The Commission for Social Care Inspection may take enforcement action against the Registered Person/Company if this requirement is not met. This is Requirement 24 of the previous report. The Registerd Person must ensure an external light is fitted outside the back door. This is Requirement 25 of the previous inspection. Previous timescale for action was 15/05/05. 31/06/05 30/06/05 21. 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. Refer to Standard 23 Good Practice Recommendations Act to ensure that the Homes adult protection measures are in accordance with the Local Authoritys Adult Protection Procedures and that staff receive familiarisation training in this connection. The registered person is advised to take careful note of the observations made at this and previous inspections in respect of the Homes environmental standards. it is recognised that it is not feasible to adapt the premises to correct some of those deficits and it is with this in mind that you are advised to consider relocating the home to more suitable premises. In considereing alternative premises the following facilities which are currently lacking should be taken into account, particularly as residents needs and expectations might change in future:- 1) The bathroom in which is located the only toilet is on the ground floor whilst all the bedrooms are on the first, which is in any case inconvenient but is likely to be more so as resdents grow older or if they become ill. 2) The communal areas as currently configured provide little scope for privacy, e.g., if residents need to consult with their agents E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 31 2. 27 and 28 9 Manor Road 3. 24 4. 5. 39 39 6. or others in private. 3) There is a lack of adequate storage space for household equipment such as the ironing and clothes airer. 4) Two of the bedrooms are below the current minimum standard (one being signifantly so) and are only legitimate because registration pre-dates the introduction of the current national minimum standards. 5) The premises do not provide any facilities for staff to store the personal belongings or for sleeping-in should this become necessary. This replaces Requirements 17 and 18 of the previous inspection report, which timescale for action was 31/06/05 The registered provider is advised to monitor the condition of the window frames throughout the Home, except that featured in requirement 11 above, and as necessary replace them with those of a type that is safe, but requires less maintenance. The registered person is advised to conduct an audit of the Homes policies, procedures and guidance and draw up a schedule for their on going review. The registered person is advised to introduce a system for receiving regulatory inspection reports and for ensuring that any requirements made therein are fulfilled in the specified timescale. Consideration should be given to whether residents best interests are served by the Homes present registration status or whether other arrangements such as Supported Housing might not be more appropriate. 9 Manor Road E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 32 Commission for Social Care Inspection 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 E53 S4480 9 Manor Road V226715 060505 Stage 4.doc Version 1.30 Page 33 - 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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