Inspection on 18/11/09 for Devonshire Manor

This inspection was carried out on 18th November 2009.

CQC 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 10/03/09

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 16/02/2010.

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 is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ingerbritt Moynihan     Date: 2 3 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 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): Type of registration: Number of places registered: Mr Thomas Charles Gorry,Mrs Patricia Mary Gorry care home 15 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. The garden is accessible by wheelchair. The home is situated in the Tranmere area of Birkenhead and is convenient Care Homes for Older People Page 4 of 25 2 9 0 6 2 0 0 9 0 Over 65 15 Brief description of the care home 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 25 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: Information about the home was obtained through discussion with the service users, 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. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? Since the last visit some improvements have been made to service users case files. Care Homes for Older People Page 7 of 25 This means staff have information on how to provide service users with the care and support they need. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 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 staff have the information they need on how to provide the right level of care. Care Homes for Older People Page 10 of 25 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 are 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 and provide staff with information on how to provide the right type of care. Service users general welfare is monitored daily and staff seek advice from different health care professionals as required. While it is acknowledged that improvements have been made to the care plans since the last visit, some aspects of service users care needs had not been addressed. Some documents were not signed or dated and health care checks were not up to date. The deputy manager was not familiar with these records and could not locate some documents. Risk assessments had been drawn up in relation to some aspects of service users care needs. The risk assessment documents need to be developed to ensure staff can identify any risk factors affecting service users well being and minimise the risk of Care Homes for Older People Page 11 of 25 Evidence: accidents happening. Without this information service users and staff could be left vulnerable to the risk of harm. As part of the visit a pharmacist inspector looked at how medicines were being handled because previous visits had found some shortfalls. We found medicines stock and records to be generally well organised and securely stored. We found the records of medicines received into the home, given to people and disposed of had improved since our last visit. Medicines were usually properly carried forward at the beginning of each monthly cycle so accounting for them was simple and easy to do. We looked at the times medicines were given and found one person was not being given their medicines correctly. On the day of the visit their morning doses were given at 12 noon but then the next dose of one of their medicines was given at 1pm. These were given too close together meaning they would not get the full benefit from them and there would be an increased chance of side effects. We saw some recent recording mistakes when staff had not recorded the administration of medicines properly even though our checks showed they had probably been given. An antibiotic was not signed as given for at least eight doses because it had not been properly transferred to a new record and a weekly tablet had not been signed for the latest dose which was two days before our visit. We saw no evidence of audits (recorded checks) of the medicines so mistakes with medicines handling were not being routinely identified and action was not being taken to help prevent them happening again. We looked at how external medicines such as creams were being handled and found the records of applying them were usually complete and accurate. However, they were not securely stored in peoples rooms and no formal recorded risk assessment about their use had been carried out. This means there was a risk of them being mishandled. Staff spoken to demonstrated an understanding of how to ensure service users are treated with respect and their right to privacy is upheld. Service users spoke highly of the staff team saying they are kind and caring. One service user said I feel well looked after and I am very happy with the homes routines. Another service user said Everything is okay and the staff are always around when I need them. Care Homes for Older People Page 12 of 25 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 small range of social activities are available so that service users have an opportunity to meet with the other people living at the home and to prevent them from becoming bored. Activities include reminiscence groups, bingo and card games. A priest visits the home weekly to ensure service users spiritual needs are met. One service users said There are no social activities provided, but I am not bothered about this. Another service user said There arent many social activities although the television is on in the afternoon. The manager should look to improving the social activities in light of service users comments. Service users family and friends can visit at any time so they can maintain personal relationships and continue to be part of family life. An assessment of service users dietary needs is carried out and diets based around their medical needs are catered for. The cook has completed training in food preparation, catering and food hygiene. A menu is not in place although a record of Care Homes for Older People Page 13 of 25 Evidence: the food provided is kept. This record reflected the meals provided over the past month were repetitive. Given that mealtimes are an important part of the day in a care home setting, a more varied menu should be provided to prevent service users from becoming bored. The cook said there is always enough food for the number of people living at the home. The kitchen was clean and tidy and appeared well organised. One of the service users spoken to during the visit said The food is really good, the cook does a lovely Sunday diner and there is always plenty to eat. Another service user said The food is excellent. Care Homes for Older People Page 14 of 25 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. Systems are in place to enable service users to make a complaint. The lack of information on safeguarding may lead to allegations of abuse being poorly managed. 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. The manager has not received any complaints. We have not received any complaints about this service. One of the service users spoken to during the visit said I would speak to the manager if I was unhappy, but I have no complaints to make. Another service user said If I was unhappy I would speak to one of the girls. 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 if taking place. The manager reported that staff are trained in this area of care although staff training records did not reflect this. No safeguarding issues have been raised with us. Neither the manager or deputy manager were clear on the procedures to follow in the event of an allegation of abuse being made. And a copy of the Wirral adult protection procedure was not available. To ensure allegations of abuse of managed properly a robust procedure must be drawn up for responding to the suspicion or evidence of abuse and neglect. This procedure should reflect the Wirral adult protection procedure. Care Homes for Older People Page 15 of 25 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. There is a programme of routine maintenance in place to maintain this standard, plans are being made to renew a number of carpets around the building. The grounds are well maintained. There is a bath hoiste on the ground floor to assist service users with their mobility. Bedrooms are clean and warm and service users have personalised their rooms with their own belongings. Staff have completed training in health and safety and policies and procedures are available to support them in their role and to ensure they know how to work safely. The fridge is kept in the laundry and on the day of the visit the cook had to move dirty linen to get to it. To prevent the possible risk of cross infection the fridge should be moved to another room. Care Homes for Older People Page 16 of 25 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 suitable staff are employed. Evidence: There are enough staff on duty to support the number of service users living at the home. Holidays and sickness are covered by the existing staff to 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. The recruitment and selection procedures ensure the necessary checks are carried out before staff are employed. A Criminal Record Bureau check is carried out before staff are employed to ensure they are suitable to work with older people. Good practice states these checks should be carried out every 3 years. The manager has introduced a policy whereby staff must declare any offences between these checks. Again this will ensure staff are suitable to work with older people. Staff have completed training since the last visit to the home. The staff training records should be updated to reflect this. Plans have been made for staff to receive training next year in moving and handling, dementia care and first aid. Care Homes for Older People Page 17 of 25 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. 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 manager of Devonshire Manor. She has owned and run the home for over twenty years. The deputy manager present on the first day of the visit was not up to date with the contents of the service users case files and could not locate important documents. She could not account for why medication had not been given to one service user and was not familiar with safeguarding procedures. On the second day of the visit, the manager was present. While she was more familiar with the general running of the home, she was not familiar with the record keeping systems and could not easily locate information. In light of this, some changes need to be made to the way the home is managed to ensure the efficient and effective running of the business and the ongoing improvement of the service. Although it is acknowledged that some improvements have been made to the way the Care Homes for Older People Page 18 of 25 Evidence: home is managed and service users said they are happy with the care they receive, the manager is not proactive in the developing the service for the future. The current quality assurance systems need to be changed to ensure the improvement of the service. The manager is also 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 supported in their role. They confirmed a senior member of staff is always available for support. Formal supervision is not provided, rather staff are informally supervised while working. A system of formal supervision should be introduced so that staff can meet with their manager to discuss their work and 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 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. During the visit a mobile commode was being used as a dining chair. This is unacceptable practice and does not promote service users dignity and presents as a possible risk of cross infection. The manager must ensure the kitchen and boiler room are kept locked when staff are not working in these areas, this will ensure service users safety at all times. The manager should obtain a Health and Safety Executive accident book so that accidents can be recorded and monitored correctly. Care Homes for Older People Page 19 of 25 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 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 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. This will ensure allegations of abuse are managed correctly. 11/06/2009 3 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. 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. 4 33 24 Care Homes for Older People Page 20 of 25 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 5 38 13 Commodes must not be used 11/06/2009 as dining chairs. This will prevent the risk of cross infection. Care Homes for Older People Page 21 of 25 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. 18/02/2010 2 9 13 Medicines must be given to people at the right time and dose. This is important to help make sure they work properly. 18/02/2010 3 17 13 A robust procedure for responding to the suspicion or evidence of abuse must be developed. This procedure must be in line with the Wirral adult protection procedure. This will ensure allegations of abuse are managed correctly. 18/02/2010 Care Homes for Older People Page 22 of 25 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 4 33 24 Improvements must be made to the way the home is managed. This will ensure the efficient and effective running of the business. 18/02/2010 5 33 24 The quality assurance 18/02/2010 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 should not be used as dining chairs. This will prevent the risk of cross infection and will promote service users dignity. 18/01/2010 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 12 More varied social activities should be provided. This will enable service users to meet the other people living in the home and prevent them from becoming bored. 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 fridge should not be kept in the laundry. This will prevent the possible risk of cross infection. Page 23 of 25 2 18 3 26 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 29 The manager should renew staff Criminal Record Bureau checks every 3 years which is in line with current good practice. Staff should be provided with formal supervision to enable them to develop in their role. 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 manged correctly. 5 6 36 38 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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