Inspection on 07/06/06 for Attwoods Manor

This inspection was carried out on 7th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Attwoods Manor 04/06/09

Attwoods Manor 16/05/08

Attwoods Manor 11/05/07

Attwoods Manor 16/09/05

Attwoods Manor 22/04/05

Attwoods Manor 24/11/04

Attwoods Manor 27/07/04

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Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Attwoods Manor Mount Hill Halstead Essex CO9 1SL Lead Inspector Brian Bailey Key Unannounced Inspection 7th June 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Attwoods Manor Address Mount Hill Halstead Essex CO9 1SL 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) 01787 476892 01787 477769 Golden Age Management Limited Mrs Gina Juniper Care Home 42 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (42) of places Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 42 persons) One person over the age of 65 years who is diagnosed with dementia and whose name was made known to the Commission in May 2005 The total number of service users accommodated in the home must not exceed 42 persons 16th September 2005 Date of last inspection Brief Description of the Service: The owner of Attwoods Manor is Golden Age Management Limited and the registered manager is Gina Juniper. Attwoods Manor is situated approximately one mile from the town of Halstead. This is a large detached period property set within approximately three acres of grounds. Accommodation consists of twelve bedrooms on the ground floor (eleven singles and one double) and twenty-eight bedrooms on the first floor (twenty-five singles and two doubles). There are four lounge areas and a large dining room. There are various bathing and WC facilities throughout the home. There is ample car parking facilities at the front of the house. The grounds are well maintained and pathways around the home are designed for the use of wheelchairs and other mobility equipment. An attractive patio area at the front of the house is an ideal area for service users to use and to meet visitors. The home is currently registered for 42 older people who need residential care. An application for the current registration to be changed to enable the manager to accommodate ten people with dementia was approved on 7th June 2006. As at 7th June 2006, the manager advised that the fees for accommodation ranged from £416 to £585 per week. Items considered to be extra to the fees include private chiropody, hairdressing, toiletries and newspapers. CSCI inspection reports are available from the home and the CSCI website. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection of Attwoods Manor was carried out on 6th June 2006. This report is based on a range of information that has been accumulated from our inspection records, a site visit to the home, discussions and observations with service users, staff, the manager and visitors, questionnaires issued by CSCI and the records kept at the home. Twentyseven standards were assessed, of these nineteen were met and the remainder were partly met. What the service does well: What has improved since the last inspection? Security at the front hall has been improved with a keypad exit system, which has made the home rather more welcoming for visitors to enter and helps to deter residents that may wander out to the adjacent road. The front patio area has also been improved with a slightly higher fence and extra seats. A room has been converted into a kitchenette with a fridge to enable staff to make refreshments for visitors. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 6 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. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives benefit from being able to visit the home to ask questions and to see for themselves whether it will meet their needs. EVIDENCE: A range of information was available in the entrance hall that included the home’s statement of purpose, service user guide, the registration certificate, planned events, the complaints and compliments book and the public liability insurance certificate. Full assessments were available on the three of the four residents’ files checked together with information gathered by the home prior to admission. One person’s pre assessment form was not signed or dated and contained minimal information. The manager was informed that the home’s recent application for the home to be able to accommodate up to ten people with dementia had been approved. The home was prepared and able to take this Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 9 into account when assessing prospective residents in the future, although the manager was clear that they would not be able to admit people with severe challenging behaviour. The manager and staff spoken to confirmed that in the majority of cases, prospective residents and/or their relatives take the opportunity to visit the home to see for themselves the facilities available, to have a meal if they want and to ask questions about the services provided. An intermediate care service is not provided at this home. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some progress has been made to ensure that the identified health, personal and social care needs of residents is reviewed at regular intervals, although there remains some care plans that have not been reviewed, which has the potential to place residents at risk. Residents benefit from a well managed system for the administration of medication. EVIDENCE: Four residents’ case records were selected for inspection. These contained a wide range of information including care plans, but again these were not always being reviewed on a regular monthly basis. Care records continue to show that visits by health care professionals were recorded and these were up to date. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 11 All medication is kept in a locked room, which is used solely for this purpose. General medication is kept within a locked trolley and controlled drugs are kept within a locked cupboard within the room. The Medication Administration Record (MAR) sheets were checked and were up to date, although it was noted that the current MAR sheets had three signatures missing. The return of medication book was not checked. All packets and bottles of medication were dated on the day of opening. The home uses a monitored dosage system. The senior on duty was again able to talk confidently about the system, procedures and expectations of her as responsible for the administration of medication and that residents were reliant on staff being competent. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to enjoy a varied programme of activities on three days each week but further opportunities should be provided over the rest of the week. Residents do benefit from being free to choose where they spend their time and from being able to have their friends and relatives visit. EVIDENCE: There was a relaxed atmosphere throughout the home. Residents were observed in a number of locations including their bedrooms, the lounges and the front garden patio. The hairdresser was at the home and residents were clearly enjoying the opportunity to have a chat and the attention. The home employs an activities co-ordinator for three afternoons per week. The coordinator was present on the day of the inspection and a large number of residents were being involved, which proved to be fun and stimulating. It was evident that all residents regardless of ability were involved. Residents spoken to said they enjoyed the activities. The opportunity to make choices however was available as some people said they preferred to remain in their rooms or to sit quietly in the lounges. The manager stated that she was trying to recruit an additional coordinator in order to provide activities on other days. Visitors Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 13 spoken to said they were made welcome at the home and can visit at any time and feel free to come and go as they please. The food was well-presented and appetising in appearance and the residents were not hurried to finish their meal. Staff were observed to sit with residents that required some assistance. The dining tables were well laid out and cold drinks were provided. The menus showed cooked breakfasts and hot snacks at teatime, which was observed on the day of inspection. Residents spoken to said that they enjoyed the meals provided and the opportunity to have a choice. The cook and staff were aware of those residents with special dietary needs including diabetics and appropriate food was provided. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives have access to a complaints procedure that they can use and feel safe that staff are trained in the protection of vulnerable adults from abuse. EVIDENCE: The home has a complaints procedure, which is included in the home’s statement of purpose. A complaints/compliments book is kept in the main entrance hall and is available for visits and residents to use. None of the residents spoken to said that they had any concerns or complaints to make about the home. The home had a policy and procedure on the protection of vulnerable adults from abuse and guidance documents produced by Essex County Council. Training certificates were available to show that staff had attended training on the protection of older people from abuse. A complaint was made to social services in 2006 about the care of a resident following an accident. The outcome of the investigation was that although there was no suggestion the person had been ill treated, there were some lessons to be learnt by staff about procedures following falls. A comment card returned to CSCI by a visitor stated that they were not aware of the complaints procedure although they had had no reason to make a complaint. A visitor spoken to said that they had no complaints and were complimentary about the care provided. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 25 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a clean, well-maintained property with attractive and extensive grounds, although an enclosed garden area would provide security for people that may wander away from the home. EVIDENCE: Attwoods is a large detached property that has been adapted to meet the needs of older people. The building is well maintained and decorated and furnished to a good standard. There are excellent views of the gardens from the lounges and dining room. Since the last inspection, some work has taken place to improve security and enable the home to accommodate people with dementia. A keypad device has been fitted to a door leading to the main hall and exit and other external doors made more secure. The boundary fence had also been raised around the patio at the front of the house to deter people from wandering away from the home. The patio was in the process of being Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 16 improved with new screening. The manager said that these measures had been introduced but was concerned about trying to get the right balance between ensuring the safety of residents and not wanting to make the home too restrictive and difficult to access. The manager has not needed to designate certain lounges or dining areas for people with dementia at this stage as the layout and the number of rooms available enables the home to be flexible according to need. A relative has commented on a questionnaire returned to CSCI that the provision of an area of the garden be made secure to enable people to walk into the garden without the need for supervision by staff. This is a valid comment that the manager needs to consider and one that could be achieved easily. A partial tour of the building was carried out that included the kitchen, laundry, lounges and dining room, bathrooms and the majority of bedrooms. All were clean and tidy and odour control was effective. Residents’ bedrooms seen were well furnished and decorated and the majority had been personalised with their own possessions. Three residents spoken to said that they were satisfied with their rooms, they were comfortable and liked being able to have some of their own possessions with them. The grounds were well maintained and a level path is available for residents use. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents may be placed at risk if the home does not implement the staff recruitment procedure at all times. EVIDENCE: The staff rosters still showed that when the manager is on duty she is still included on the roster as a carer. To determine the staff numbers required in a care home, the manager’s hours are excluded in recognition of the need to undertake managerial duties that include the supervision of staff and assessment of residents’ needs. The manager must therefore be supernumerary to the care staff for a number of shifts each week. Three staff files were selected at random and checked. These showed that the manager was generally following procedures and carrying out all the necessary recruitment checks for new staff, which included completed application forms and two references being obtained. Criminal Records Bureau disclosure checks were available for two staff although there was no disclosure for the third person. The files were well maintained and kept secure in the office. Information was available to show that staff are provided with opportunities to access training courses, that include medication, dementia awareness, National Vocational Qualifications (NVQ), Health and Safety, bereavement, equality and Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 18 diversity and the protection of vulnerable adults from abuse. The home has an induction programme that all new staff are required to undertake. Of the 12 care staff employed, 8 have obtained a NVQ at level 2. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents, staff and other people with an interest in the home are still not consulted as part of the Quality Assurance system. The manager is not able to monitor adequately the standards of care whilst working as a member of the care staff team. Residents benefit from the home having a good financial control system in place. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager has several years experience of managing a care home for older people and has attained a Registered Managers Award. The current staffing arrangements do not permit the manager sufficient time to carry out her full managerial duties effectively. The home has a Quality Assurance system in operation. A survey of relatives to gauge their opinions about the services provided was carried out in 2006. The manager has received a total of fourteen responses and a summary of the feedback is due to be published. A copy of the report must be submitted to CSCI. The survey did not include service users, health care professionals and other visitors with an interest in the welfare of residents. The home’s policy is that the manager does not look after residents’ money for safekeeping. The procedure is that the administrator invoices the residents’ relatives direct for any expenditure and monies owed. All invoices and receipts checked were correct and financial record keeping within the home is good. The monthly invoices to relatives contained sufficient information to show they only included those items considered as extra to the fees, such as chiropody, toiletries and newspapers. Although it was not apparent that there were any Health & Safety matters outstanding, detailed information was not provided to CSCI when the home completed a return in January 2006 and was not readily available at the home at the time of the site visit. Information regarding the servicing of equipment and services under the health and safety regulations must be made available for inspection at all times. It was noted however that staff training during the past year has included fire training, food preparation, moving and handling and first aid. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 X 3 X 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement The manager must ensure that comprehensive assessments of prospective residents are obtained and are dated and signed. Residents’ care plans must be reviewed regularly (Timescale 1/12/05 not met). The manager must ensure that all medication administered to residents is signed by the staff member. The manager must provide opportunities for activities over more days each week. The manager must consider how all residents can be enabled to access a secure area of the garden without the necessity to be accompanied by staff. The manager must organise the staff roster to ensure that the majority of her working hours each week are supernumerary to the care staff. (Time scale of 01/11/05 not met) Timescale for action 01/09/06 2 OP7 15 01/09/06 3 OP9 13 01/09/06 4 5 OP12 OP20 16 23 01/10/06 01/01/07 6 OP27 18 01/10/06 Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 23 7 OP29 19 8 OP33 24 9 OP38 13 CRB disclosure checks must be 01/08/06 obtained for all new staff prior to them commencing work at the home. The manager must provide CSCI with a copy of any report in respect of a review of the quality of care provided at the home. 01/10/06 The manager must also undertake a survey of residents to obtain their views about the services provided. Health & Safety information 01/08/06 must be readily available for inspection at all times. Schedules of when the servicing of equipment and services was last carried out, together with confirmation that all staff have received the mandatory H & S training, must be provided to CSCI. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP12 OP20 OP33 Good Practice Recommendations The manager should continue to try and recruit an additional activities coordinator. The manager should enable residents to access an area of the garden that is secure to avoid the risk of a person wandering off to the busy road outside the property. The manager should arrange to obtain feedback about the services provided from staff, health care professionals and all other people with an interest in the home. Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Attwoods Manor DS0000017756.V298453.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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