Inspection on 10/03/09 for Devonshire Manor

This inspection was carried out on 10th March 2009.

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

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

Other inspections for this house

Devonshire Manor 18/11/09

Devonshire Manor 11/03/08

Devonshire Manor 04/12/06

Devonshire Manor 04/05/06

Devonshire Manor 09/03/06

Devonshire Manor 20/09/05

Devonshire Manor 12/01/05

Devonshire Manor 29/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Devonshire Manor 38 - 40 North Road Birkenhead Wirral CH42 7JF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ingerbritt Moynihan     Date: 1 1 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Devonshire Manor 38 - 40 North Road Birkenhead Wirral CH42 7JF 01516522274 01516536731 Noemail Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Thomas Charles Gorry,Mrs Patricia Mary Gorry Name of registered manager (if applicable) Mrs Patricia Mary Gorry Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 15 Date of last inspection Brief description of the care home Devonshire Manor is registered to provide personal care to 15 older people. There are 13 single and one double bedroom. The home has two floors and a mezzanine floor. Bedrooms are situated on all floors. A stair lift is available. Toilets are situated on the ground, first and mezzanine floors. There is a bathroom on the ground and on the first floor and bathing aids are provided. Communal space is provided in a lounge with through dining room. There is car parking space at the front of the building and a ramp for wheelchair access. A paved outdoor area is provided with flowerbeds and shrubs. Care Homes for Older People Page 4 of 27 care home 15 Over 65 15 0 Brief description of the care home The garden is accessible by wheelchair. The home is situated in the Tranmere area of Birkenhead and is convenient for local bus routes across the Wirral. There is a small selection of shops within walking distance. It costs #352 per week to live at the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The people who live at the home are referred to as service users so this term is used throughout the report. Information about the home was obtained through discussion with the service users, the manager and members of the staff team. Policies, procedures and supporting documentation were also looked at along with a selection of service users case files. Before the visit the provider was sent an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment document that is filled in once a year by all providers. It is one of the ways that we get information from providers about how they are meeting outcomes for people using the service. The AQAA was not returned to us therefore we were unable to make an accurate judgment about how the service is Care Homes for Older People Page 6 of 27 meeting outcomes for people using the service and what improvements the manager has made for the improvement and development of the service. The manager reported she did not receive the AQAA although our records show this was sent out. A copy of this report, and previous inspection reports, can be obtained from the manager at the home. What the care home does well: What has improved since the last inspection? What they could do better: Detailed risk assessments need to be completed to ensure service users safety and welfare. Improvements need to be made to the medication procedures to ensure service users medication is managed correctly. All staff should receive an update in their safeguarding training to ensure allegation of Care Homes for Older People Page 8 of 27 abuse are managed correctly. This training should also be included in the forthcoming years training programme. A training plan for the forthcoming year should be drawn up so that staff can develop in their role and the service can improve and promote best practice. Although staff have completed a Criminal Record Bureau check, good practice indicates these should be updated every three years. Staff should be provided with formal supervision so they have opportunity to discuss their work and develop in their role. The manager should introduce a system of continuous self monitoring and ongoing improvement so she can be proactive in developing effective administrative systems to support staff with the care they provide. Some improvements need to be made to the way health and safety is managed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users care needs are assessed before a service is offered so they know they will receive the care and support they need. Evidence: An assessment of service users care needs is carried out before they move into the home. Service users, their family and any relevant health care professional can contribute to the assessment to ensure the staff have the information they need on how to provide the right level of care. Intermediate care is not provided at Devonshire Manor. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements need to be made to the way service users health and personal care is managed to ensure their changing care needs and met. Evidence: A plan of the care provided to each service user is in place. The care plans cover a range of issues relating to service users different care needs. Service users general welfare is monitored daily and staff will seek advice from different health care professionals as required. The care plans should be regularly reviewed to ensure they accurately reflect service users changing health and personal care needs. A record of this information must be kept so that staff can monitor service users welfare in more detail and be proactive in planning and managing their care. While information relating to service users care needs is collated, risk assessments have not been drawn up. To ensure staff identify any risk factors affecting service users well being and to minimise the risk of accidents happening, detailed risk assessments must be completed. Without this information service users and staff could Care Homes for Older People Page 12 of 27 Evidence: be left vulnerable to the risk of harm. Service users made positive comments about the care they receive. One service user said The staff are very nice and there is always someone around. Another service user said This is quite a nice home and the staff are very nice and very kind. I feel well looked after. The service users spoken to confirmed they see their GP when necessary and they receive the medical support they need. The service users said the staff are prompt to respond to their medical care needs. Staff spoken to demonstrated an understanding of how they ensure service users are treated with respect and their right to privacy is upheld. One service user The staff are very good when they help me with my personal care. However, on the day of the visit two commodes were being used as dining chairs. This is unacceptable practice and does not give service users the respect they deserve. Systems are in place for the administration of service users medication and staff have completed training in this area of care so they are aware of their responsibilities and know how to work safely. One of the medication administration record sheets was not accurately maintained. The records had been signed to indicate medication had been given when it had not. Also medication had been pre dispensed into small pots which is against current good practice. The manager must review the current procedures to ensure medication is managed properly. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes routines are flexible and service users are helped to exercise choice and control in their lives. Evidence: A range of social activities are available to ensure service users have an opportunity to meet with the other people living at the home and to prevent them from becoming bored. The manager explained that service users have their own routines and do not want to join in with these activities. A priest visits the home every now and again. The manager acknowledged that service users would like to see him more often and agreed to ask him to visit more regularly. One service user has regular visitors from the Jehovahs Witness church. Service users family and friends can visit at any time so they can maintain personal relationships and continue to be part of family life. The service users spoken to said they enjoy the food and always have plenty to eat and drink. An assessment of service users dietary requirements is carried out. Diets based around service users medical needs are catered for and staff are available to Care Homes for Older People Page 14 of 27 Evidence: support service users at mealtimes. One of the service users said The food is always very good and I always get plenty to eat. Another service user said The food is fantastic. There is always plenty to eat and more if you want. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users know who to contact if they want to make a complaint. The lack of current information on safeguarding may lead to allegations of abuse not being managed properly. . Evidence: A complaint procedure is available to service users and their relatives so they know what to do if they are unhappy with the care they receive. The manager has not received any complaints about the service and staff are clear on the action they should take in the event of them receiving a complaint. We have not received any complaints about Devonshire Manor. One of the service users spoken to during the visit said I can speak to the manager if I am unhappy with the care I receive. Another service user said I am very happy living at Devonshire Manor and have no complaints to make. During discussion staff demonstrated a basic understanding of the different types of abuse that can occur and what they should do if they know or suspect abuse taking place. Although staff have completed training in this area of care this was in 2004 or 2006. Safeguarding adults from abuse is not part of the homes training programme and the manager was not sure if it was included in the staff induction training programme. The manager agreed to ensure all staff are provided with an update in their training by April 2009. She will also update the staff induction training programme and ensure it is included in the forthcoming years training programme. Care Homes for Older People Page 16 of 27 Evidence: The manager acknowledged her own knowledge of this area of care needs to be updated. The manager must have a robust policy in place for responding to suspicion or evidence of abuse and neglect. This policy must be in line with the Wirral adult protection procedure to ensure allegations of abuse are managed correctly. The manager is advised obtain a copy of the Wirral adult protection procedure to support her with this task as this was not available on the day of the visit. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building is well maintained and provides a comfortable and homely environment for service users to live. Evidence: Devonshire Manor is maintained to a good standard and provides a homely environment for service users to live. Over the past year improvements have been made to the home. The outside of the home has been painted and the car park has been resurfaced. New bedroom carpets and beds have been provided and the chairs in the lounge will be renewed later this year. Special equipment is provided to ensure service users independence. Systems are in place to prevent the spread of infection. Staff have completed training in this area and policies and procedures are available to support them in their role and ensure they know how to work safely. The service users spoken to during the visit said they are comfortable in their room and have everything they need. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment and selection procedures ensure suitably qualified and competent staff are employed. Staff training needs to be developed to allow staff to develop in their role. Evidence: The manager and staff reported there are sufficient care staff employed at the home to support the number of service users living there. Holidays and sickness are covered by the existing staff team to ensure continuity of care. There is ongoing training to the National Vocational Qualification standards which is a recognised qualification for staff involved in the care profession. This means staff are kept up to date with with new ways of working. The recruitment and selection procedures ensure the necessary checks are carried out before staff are employed. A Criminal Record Bureau (CRB) check is carried out for each member of staff. The records looked at indicated these were completed in 2003 and 2006. Good practice states this check should be completed every three years. The manager agreed to ensure outstanding CRB checks are updated. The manager should also introduce a policy whereby staff must declare any offences between these checks. This will ensure they continue to be suitable to work with older people. Care Homes for Older People Page 19 of 27 Evidence: Staff completed a range of health and safety training last year. A training plan for the forthcoming year is not in place. So that staff can develop in their role and the service can improve and promote best practice, a training plan should be developed. This training plan should reflect the service users specialist care needs and the staff training requirements. The manager is advised to carry out an audit of staff training needs. The outcome of this audit should formulate the basis of the training plan. Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements need to be made to the way the home is managed to ensure the ongoing improvement of the service. Evidence: Mrs Gorry is the registered manager and has owned and run the home for over twenty years. She has recently enrolled on National Vocational Qualification level 4 which is the recognised qualification for a manager of a care home. Last year the manager introduced a quality assurance system into the home. The purpose of this is to identify where improvements can be made and to introduce a system of continuous self monitoring and ongoing improvement. Although some work has been done to assess the standard the home is operating at, this work has not been completed. The manager acknowledged that administrative systems are not her strength and that more work still needs to be done to improve this area for the purpose of ensuring the ongoing improvement of the service. While it is acknowledged Care Homes for Older People Page 21 of 27 Evidence: that improvements have been made to the service over the past year and service users are happy with the care they receive, the manager is not proactive in developing the service for the future. The manager is advised to install an IT system which gives access to the internet and professional websites to enable her and the staff team to keep up to date with changing policies and procedures and developments in the care sector. Service users manage their own finances. Staff are monitored and supervised by the manager who works alongside them each day. Staff spoken to said they enjoy their work and feel well supported in their role. They confirmed the manager or a senior member of staff is always available for advice. Formal supervision is not provided. Formal supervision is when staff meet with their line manager on an individual basis for the purpose of discussing their work and developing in their role. The manager should develop a system of formal supervision for staffs professional development. The health, safety and welfare of service users and staff is promoted through the provision of staff training and policies and procedures. Health and safety checks are carried out around the building to ensure the safety and welfare of everyone in the home. Some improvements need to be made to the way health and safety is managed. A system for checking legionella should be set up and the fire safety risk assessments and staff fire safety training needs to be updated. The manager should obtain a copy of the Health and Safety Executive accident book so that accidents can be recorded and monitored correctly. Although a risk assessment was in place, this was not dated. This risk assessment must be updated due to the potential danger bed rails present. A system of visual checks must also be set up for the use of this equipment. During the visit mobile commodes were being used as dining chairs. This is unacceptable practice as it presents as a high risk of cross infection. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 33 24 Improvements must be 31/12/2008 made to the way the home is managed to ensure the effective and efficient running of the business. Care Homes for Older People Page 23 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 15 Detailed risk assessments must be completed in all areas of service users care. This will ensure staff have the information they need on how to keep the service users safe from the risk of harm. 11/06/2009 2 10 13 The medication 11/06/2009 administration record sheets must not be signed until after the medication has been given. This will ensure staff know service users have taken their medication as prescribed. 3 18 13 A robust procedure for responding to suspicion or evidence of abuse must be developed. This procedure must be in line with the Wirral Adult Protection Procedures. 11/06/2009 Care Homes for Older People Page 24 of 27 This will ensure allegations of abuse are managed correctly. 4 18 13 All staff should be provided with an update in their safeguarding training. This training should also be included in the homes future training plan and the staff induction programme. This will ensure staff are aware of the signs of abuse and how an allegation of abuse must be managed. 5 33 24 The quality assurance 11/06/2009 systems and supporting administrative systems need to be improved. This will ensure a system of continuous self monitoring and ongoing improvement is introduced. 6 38 13 Commodes must not be used as dining chairs. This will prevent the risk of cross infection. 7 38 23 Fire safety risk assessments and staff fire safety training needs to be updated. This will ensure staff know what to do in the event of a fire and ensure the service users safety and welfare. 8 38 13 An up to date risk assessment must be completed when bed rails are used. 11/06/2009 11/06/2009 11/06/2009 11/06/2009 Care Homes for Older People Page 25 of 27 This will ensure staff have the information they need on how to minimise the risk of accidents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 18 A copy of the Wirral adult protection procedure should be available to all staff to ensure allegations or suspicions of abuse are managed correctly. The manager is advised to install an IT system which gives access to the internet and professional websites. This will enable staff to keep up to date with changing policies and procedures in the care sector. Staff should be provided with formal supervision to enable them to develop in their role. The manager must update the fire safety risk assessments to ensure the safety of staff and service users. A Health and Safety Executive accident book should be used to record details about any accidents that occur. This will ensure accidents are recorded and managed correctly. 2 33 3 4 5 36 38 38 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!