Inspection on 31/08/07 for Flixton Manor

This inspection was carried out on 31st August 2007.

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

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

Other inspections for this house

Flixton Manor 30/10/08

Flixton Manor 25/01/08

Flixton Manor 27/06/06

Flixton Manor 15/02/06

Flixton Manor 28/12/05

Flixton Manor 15/02/05

Flixton Manor 18/08/04

Flixton Manor 29/03/04

Flixton Manor 16/12/03

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Flixton Manor 2-8 Delamere Road Flixton Manchester M41 5QL Lead Inspector Elizabeth Holt Unannounced Inspection 31st August 2007 10:00 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 Flixton Manor DS0000006711.V335569.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. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Flixton Manor Address 2-8 Delamere Road Flixton Manchester M41 5QL 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) 0161 746 7175 0161 748 5583 flixtonmanor@msn.com Dr Jan Al Safar vacant post Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. All service users will fall within the category of old age (60 ). Up to three service users who require personal care may be included within the maximum occupancy. Staffing levels as specified in the Section 25 (3) Notice dated 28th September 2001 shall be maintained. 8/03/07 Date of last inspection Brief Description of the Service: Flixton Manor is a care home providing nursing care and accommodation for 32 older people. The home had been converted into one residence from two semi-detached houses. Further additions have taken place to enlarge the communal areas and an extension to provide bedroom accommodation. There was a large conservatory at the front elevation of the home that leads into the lounge and dining areas. Access to the home is from the drive and garden. At the end of the drive there is provision for parking. There are concrete steps and a ramp for wheelchair access to the entrance door. The home is situated on the main road between Flixton and Urmston. There was easy access to public transport, local shops and parks. It is convenient for the motorway system. The current scale of charges at the home is £384-£550.00 per week. Costs in addition to the fee are hairdressing £4.50-£16.00, Chiropodist £20.00 per visit, newspapers-varied and toiletries which are charged on an individual needs basis. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was undertaken as part of a key inspection, the site visit started at 10.00am on the 31st August and it lasted for six and a half hours. The home did not know the inspector was going to visit. A further visit was made by the specialist pharmacy inspector on the 4th September 07 and the findings of this are included in this report as part of this overall inspection. A pre-inspection questionnaire was completed by the manager and was received before the inspection. Two service user survey forms were completed by residents and their families and returned to the Commission and two staff surveys were completed and returned. The home’s manager was appointed in July 2007 and her application has not yet been submitted for her to become registered with the Commission due to a delay out of her control. The term preferred by the people consulted during the visit was “residents”. This term therefore, is used throughout the report when referring to the people living at the home. What the service does well: What has improved since the last inspection? Some improvements to the environment have been made since the last inspection including; homely lighting fitted throughout the home, aids and adaptations have been replaced, three new nursing beds provided, odour Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 6 management systems in place and the entrance hallway has been moved away from the resident’s lounge. The staffing levels have been increased by one care staff member, on the morning and afternoon shift in line with an increase in the number of residents accommodated and two new staff members have been employed for housekeeping duties since the last inspection. The home offers some leisure activities for the residents, however this could be developed further. There is an ongoing programme of staff training and development which the staff found interesting. What they could do better: The Statement of Purpose should include the objectives and philosophy of the home; and provide good detailed information about what a prospective resident can expect in the home so that residents and their families have the information to be able to make an informed choice about the home. Since the last inspection the manager has made some attempts to improve the care plans however, a full audit is needed of all the care plans to ensure these accurately reflect the care needs of the residents living at Flixton Manor. Shortfalls noted in the staffs ability to record appropriate information in the care plans may put people at risk of not having their health, personal or social care needs met in full. Risk assessments should be appropriately completed particularly linked to the health, safety and well being of each resident. Staff must ensure personal care routines are part of the daily care programme and include nails and hair. A number of shortfalls in relation to the policies and procedures for the management, administration, storage and recording of medication must be improved. Shortfalls in the length of time taken to act on information and treatment from other professionals may lead to the health care needs of people not being met in full. The home could improve the amount of activities and stimulation provided for residents and should consider employing the services of a person dedicated to social activities according to the needs and wishes of the residents. The registered person for the home has failed to inform the CSCI of all significant events that have occurred at the home since the last inspection. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 7 The programme of redecoration and refurbishment of soft furnishings in the home is very slow and some of the bedrooms require updating and decorating. The kitchen area in the dining room must be upgraded and the food trolley replaced to make sure the residents and staff are safe and the environment is more pleasant for the residents. As raised in previous inspections sluicing facilities remain basic and a plan must be provided to develop this in the home to reduce the risk of cross infection. 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. The summary of this inspection report can be made available in other formats on request. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 8 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 Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are assessed before they are admitted to the home however shortfalls in the home’s in-house procedures are not sufficient to ensure the resident’s needs are always identified and planned for, which may lead to the home not meeting their care needs. EVIDENCE: The Statement of Purpose and function had been revised since the last inspection, however the document did not contain all the relevant information required by schedule 1 of the Care Homes Regulations 2001. The Statement of Purpose should set out the homes objectives, including how the service provides for the needs of people with dementia and be supported by the resident’s guide that provides good clear information about the home. An information package was given to prospective residents and their families to inform them about Flixton manor. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 10 There is a pre-admission assessment format for residents before they are admitted to Flixton Manor. These assessments were carried out by the Registered Nurse employed, by the home who is considered suitably qualified to carry these assessments, however a review of three of these did not give the reader a very clear picture of the resident’s care needs at the admission stage. The information lacked detail about the specific needs of the prospective resident. Where placements were funded from Social Services copies of the Care Management assessments were available, which gave detailed information about the resident’s needs. Shortfalls were noted in the staff putting the information together to provide a care plan to highlight the resident’s individual needs and to enable the home to show they can meet the resident’s assessed needs. Shortfalls in this recording process may lead to residents needs not being met in full. One new resident said, “The staff are very kind, I am happy here and settling in well.” The home did not provide intermediate care. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plans and risk assessments lacked detail to clearly show the current and changing needs of the residents were being appropriately met; the procedures for management of medication were inadequate and had potential to put residents at risk. EVIDENCE: Following a review of a sample of resident’s care plans a number of shortfalls were noted, as information gathered during the pre-admission and assessment phase was not followed on in the care planning and implementation phase. Three resident’s care plan showed a number of serious shortfalls including the following examples; appropriate nursing assessments were not identified in relation to the support the resident required with poor mobility and chest pain. There was no signed agreement to show the resident was safe and competent to manage his or her own medication. A resident who has specific skin care needs did not have these needs clearly recorded in the plan of care. Shortfalls in the detail provided may lead staff to not care for this resident appropriately. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 12 Moving and handling assessments for new residents were not available and some of the completed assessments stated, “needs two carers” for repositioning but did not specify the equipment required. Care plans did not specify the sling type or size to be used or the equipment/hoist to assist the transfer. One resident’s nutritional risk assessment had not been fully completed and the information provided on the hospital assessment had not been adequately followed up since the resident was admitted to the home. Since the inspection the senior nurse has discussed this referral with the General Practitioner and requested this to be followed up. Shortfalls in the information provided for the care staff may lead to the residents’ needs not being met and put their health care needs at risk. A number of residents were nursed in “Kirton” or “bucket” chairs, which are deep seated chairs that are difficult to get out of and may therefore be seen as a form of restraint. This been raised in previous inspection reports and caution must be used when using these chairs as inappropriate use may be seen as abuse. Such equipment must be used in exceptional circumstances to protect a resident’s welfare and risk assessments for the use of these chairs must be clearly recorded and be included in the care plan. Care plans were not person centred and there was no evidence that residents’ or their representatives had been consulted about their plan of care. A form had been developed however for the resident’s reviewed these forms had not been completed. Some improvements were seen in the use of the body-mapping tool and in the recording of skin tears or existing wounds. It was of serious concern that the manager or nursing staff were not following up the advice/treatment required from other healthcare professionals in a timely manner to support the healthcare needs of the resident’s accommodated. It was of serious concern that staff were not acting on the assessed information, which potentially has serious concerns for the well being of the residents. This concern was raised at the previous inspection and a requirement was made for a full audit of all care plans to ensure they set out the action needed by staff to ensure all aspects of the residents’ health, personal and social care needs are met. The home had a number of bed safety rails in use and improvements had been made to the risk assessment for the use of these. One set was not well attached to a divan bed and the proprietor must ensure the safety of this. The general condition, safety and safe attachment to the bed of these rails must be checked on a daily basis with a record kept of this check. The need to continue to replace the three divan beds left with nursing beds must continue for residents in receipt of nursing care. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 13 As part of this inspection the pharmacist inspector looked at all aspects of medication handling to assess how safely it is done. The medication policy for the home was not a single document and it did not cover all areas of medication handling. The various pages of the medication policy and procedures should be brought together as a single document and reviewed to make sure staff have clear guidance on the safe handling and administration of medicines so that residents’ heath is not at risk. Medicines were not stored safely in the home; the nurses said that the room in which medicines were stored was always left unlocked. During the morning medicines round the medication trolley was left open and unattended for quite a long time which meant that anyone in the conservatory had access to large quantities of prescribed medicines which is potentially harmful to residents’ health. The standard of record keeping regarding medicines handling was poor. The records did not accurately show how much medication was kept in the home for each resident and so it was not always possible to tell if medication was being administered as prescribed by the doctor. It was also not always possible to account for medication accurately. Samples of the Medication Administration Record sheets (MARs) were looked at together with the medicines in the home. It was seen that some medicines which had been recorded as administered could not have been given either because the medication was recorded as being unavailable or because the medication was still in the container or bottle. Other medicines, which had not been signed for, as given, may have been administered because the tablets were not in the blister packs or accounted for in any other way. It was of serious concern that medication was not being given to residents as prescribed by the doctors. On the day of inspection the morning medication round was not completed until about 11.30 am, this meant that residents’ health could be at risk because their medicines were given too close together or too far apart to work properly. These medicines included analgesics and antibiotics. Medicines, which had special instructions such as ‘to be taken with food, were not given with food; which could cause risk of harm to residents’ health. There was further concern that some residents were unable to be given their medication because it had run out. One example showed that a resident could not have all her medication given to her for almost 3 days because there was none available in the home, this residents health could have been placed at risk of harm. It was also seen that on some occasions nurses failed to follow the directions on the label and, for example, signed that cream had been administered more often than it was prescribed. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 14 Some residents’ health was potentially put at further risk by nurses leaving prescribed creams in residents’ rooms when no check had been made to find out if it was safe to do so. A risk assessment must be made to ensure that any medicines, which are kept in people’s rooms, can be done so without putting residents’ health and well being at risk. The manager did not have a system of auditing medication or checking how well medication was being handled and administered, and could not show that residents’ health was protected by having a high standard of medication practice. These poor systems for the management of medication gives serious concern and requirements have been made for the safe management of medicines in the home. From observations made during the inspection and conversations with staff members, residents and visitors, it appeared the care staff and nurses were respectful to the residents in the way they spoke to them. Some observations led to the resident’s dignity being compromised, for example staff were seen to stand up to support residents at mealtimes, another resident could not easily access her food from the position of the table and some of the resident’s finger nails looked uncut and unclean. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are given some opportunity to exercise control and choice over their lives but shortfalls in activities and stimulation may put the residents progress at risk. EVIDENCE: There is recognition that the residents do vary in their wishes and their capacity to be involved in social activities, however the care plans do not clearly reflect the social and recreational wishes of the residents’ accommodated. There is a weekly programme of in house activities, which staff commented they did try to stick to particularly late morning and afternoon following care delivery. A number of the residents were seen to sleep for a lengthy period of time in their chairs in the dining room. Prior to lunchtime staff were heard encouraging some of the residents to participate in singing, which they said afterwards they had enjoyed. The residents would benefit from a person dedicated to provide activities and social stimulation and a requirement was made. Care plans did not include a full social profile assessment however there was some evidence of life histories which had been completed by family members. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 16 Outings have been encouraged more since the last inspection and some attempts to record these had been made. One resident had recently been out to the pub while another resident had been for a coffee with a staff member following a dental appointment. One resident had been on a local shopping trip on the morning of the inspection and said, “It’s cold but good to get out”. One resident said she would like the opportunity to spend more time in her bedroom, however the nurse spoken to said the resident asked to come out, when we take her to her bedroom. Two resident survey forms were returned to the Commission and both stated that there are “sometimes activities arranged by the home they could take part in”. One resident commented further that there could be more activities provided. Staff members spoken to said they enjoyed encouraging activities but would value more input to assist them in this. The residents were encouraged to bring in personal items into the home such as photographs, pictures and ornaments. The staff were seen to speak to residents in a friendly way and knew the residents well. There is an open visiting policy and the three visitors spoken to said they were always made to feel welcome in the home. One of the visitors said, “I am generally happy with the care my mother receives and I feel the staff try very hard.” The meals were served in the dining area of the main lounge/conservatory and the tables were pleasantly laid. Residents who could express a view said they were generally satisfied with the food provided and they felt they got enough to eat. The main meal on the day of this visit was fish, chips and mushy peas and an alternative was available. The teatime meal of sandwiches and tinned fruit and cream had been prepared at quarter to four. A relief cook (cook was on holiday) was in post and the manager was asked to discuss the timing of this with him and the restriction of choice with the cream. The menu was not displayed in the home and this would ensure that the residents are made aware of the choices available to them. A discussion with the manager showed that a residents satisfaction survey had been carried out by the home and some changes had recently be made to improve the menu in line with the likes and dislikes of the residents. Two cards recently received from relatives said, “I am very satisfied with the level of care you are providing and the contact you maintain with me. Keep up the good work.” The other relative wrote, “We would like to say that mum is very happy at the home and is very well cared for and we are very grateful for all the staff and management in what they do”. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear complaints procedure that ensures concerns are appropriately dealt with and procedures were in place to protect residents from harm. EVIDENCE: The home had a complaints procedure and a record of concern/complaints was held by the home. The two complaints made showed these to have been appropriately dealt with within timescales. An issue raised in one of the complaints was in relation to accessing medication for a resident out of hours. Although this was managed appropriately by the home after the event it is of concern that issues arising from this still remain as a resident had gone for a number of days before the prescribed medication was sought. The Commission for Social Care Inspection had not been in receipt of any complaints about the home since the last inspection. The two responses to the service user surveys showed that they were aware of how to make a complaint and whom they would approach in the home. All staff had received awareness training through Trafford’s training consortium in adult safeguarding procedures. The home has a copy of the local interagency adult protection policy and procedure. Staff spoken to during this visit showed awareness of what they would do if they suspected someone was being abused. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 24 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in the attention to soft furnishings, furniture and some equipment may lead to residents living in an environment, which is not as safe or as homely as it could be. EVIDENCE: The home was generally clean and free from offensive odours however a new damp proof course was being put in which made the downstairs dusty. The two resident survey responses received by the Commission showed that the home was usually clean. Since the last inspection new homely lighting has been installed in residents’ bedrooms, lounges and dining rooms. This work has led to the need for some re plastering and redecoration due to the changes made. Urgent attention must be made to bedroom 25 where the over bed light has been replaced but the plaster is coming away from the wall. A partial tour of the premises, which included the communal areas, bathrooms and toilets, was carried out with the Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 19 manager. This identified a number of areas that required improving; a programme of redecoration for the bedrooms is required, as a number of these are looking tired and outdated. The chipped paintwork on the skirting boards and corridors throughout the home need attention as raised at the previous inspection. It was pleasing to see some bedroom furniture had been replaced however there were some items of furniture noted during the inspection that must be replaced to ensure residents have an adequate standard of furniture in their bedrooms. Curtain rails in two of the bedrooms had become removed from the wall and required urgent attention. Discussions have been held in the past in relation to the provision of a sluicing disinfector. This has still not been addressed although quotations were being sought at the visit in March 2007. Staff are potentially at risk of injury due to the process required to clean the commode buckets and action must be taken to minimise the risk of infection in the home. One of the survey responses expressed a view that there were not enough toilets for female use only and these were not clearly marked. There were no signs of any orientation aids throughout the home to assist any of the residents with dementia. The bedding throughout the bedrooms and in the laundry looked very worn and “tired”, duvets and pillowcases require replacing. The ironing board looked in need of replacement and the sheepskins should be removed, as they are no longer considered good practice. The kitchen area next to the dining area required the food trolley replacing as a matter of urgency, the work surface, draining board had lifted and the cupboards were in a poor state of repair and required urgent attention. The manager stated that there were plans to renew the shower tray and screen to the shower on the ground floor of the home. As raised previously the temperature in the lounge/conservatory and some of the bedrooms remains uncomfortably warm and both residents and staff commented this on. Air conditioning had been installed however this requires further monitoring in order to maintain a comfortable atmosphere within the home. Shortfalls in the environment lead the home to being unsafe and not homely for the residents accommodated. Aids and adaptations have been updated around the home and improvements to manage the control of infection in the home have been made since the last inspection. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to meet the needs of the residents accommodated and the recruitment procedures and training of staff ensured the residents are looked after by suitably recruited individuals. EVIDENCE: At the time of the visit the home had 29 residents in receipt of nursing care. The staff rotas and a discussion with the manager showed that the number of care staff on duty had been increased by one care worker in the morning and afternoon shifts since the last inspection to meet the needs of the residents. From observations made during the visit there appeared to be sufficient staff on duty to meet the care needs of the residents. The manager had improved the staff files since the last inspection, however these must be now be stored in a lockable facility. A sample of staff records reviewed showed that recruitment policies and procedures are followed, with the background checks carried out prior to employment. Training and supervision arrangements are in place and staff spoken to were pleased with the opportunities for study they received. Pre inspection information supplied by the manager showed that 96 of staff have their NVQ level 2 or above. This includes the ten overseas staff the home Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 21 employs who hold a nursing qualification who currently work as care staff in the home. Other pre inspection information showed that staff had received training in a number of areas including the following; diabetes awareness, manual handling, infection control, death and dying, first aid and dementia. There was evidence on the staff files to show when the training had taken place and certificates were available within the individual training plans. A discussion with the manager showed the need to ensure there is a system to show when staff require mandatory training. Currently this is a manual system and up to date records are held. Visitors and residents said the staff and management are very approachable and it was clear that staff had friendly relationships with the relatives visiting the home. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards and practices in the home did not promote and safeguard the health, safety and welfare of the residents living there. EVIDENCE: Since the last inspection the provider has put in new management arrangements. Mrs Simcock has been employed at the home for six years and is currently studying for her registered managers award. The Commission has not yet received the manager’s application, however the provider has stated this is only awaiting her criminal records check before this can be submitted. A temporary Clinical Lead Nurse is currently supporting Mrs Simcock. Following the concerns raised during this inspection in relation to the healthcare needs of the residents and the shortfalls in the management of Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 23 medication in the home an improvement plan will be requested by the Commission with timescales to show how the provider intends to manage the home and ensure the health, safety and welfare of the residents. The manager and senior staff of the home had failed to inform the Commission under regulation 37 of the Care Homes Regulations 2001 of some of the notifiable incidents that had taken place since the last inspection. This information has since been provided to the Commission. The home has a policy for the management of resident’s finances however there were only pocket monies for a small number of residents being managed at the time of this visit. Appropriate records were in place with receipts to show any money spent. It was evident the manager was trying to make improvements in the home and had made a number for the benefit of the residents since July 2007 when she was appointed by the home. Mrs Simcock showed a good knowledge of the residents, however as a non-nurse, the clinical leadership of the residents is also needed. There is a system in place for seeking the views of residents, relatives and visiting professionals and using these to highlight areas of improvement for residents. Changes to the menus had been made following the recent views of residents and moving the entrance away from the resident’s lounge to the hallway had also been acted upon. Accidents and incidents were being recorded in a guidebook that met the requirements of the Data Protection Act 1998 and there was evidence the manager and nurse in charge were monitoring these. A full audit of the policies and procedures in relation to health and safety had been carried out by the manager and the pre inspection questionnaire provided, showed these had been updated/reviewed this year. Records of fire safety checks were available and fire safety equipment checks had been carried out by an authorised company this year. A gas safety record was available dated 17/05/07. Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 24 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 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 1 X X X X X 1 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)(a) Requirement Timescale for action 26/10/07 2. OP7 15 3. OP8 13(4) 4. OP8 13(7)(8) The needs of new residents must be assessed by a suitably qualified or trained person; to ensure the home can meet their needs. A full audit of all care plans must 30/10/07 be undertaken to ensure they set out the action which needs to be taken by care staff to ensure all aspects of the residents health, personal and social care needs are met. This must include wound care. (The previous timescale of 30/05/07 had not been met.) Risk assessments must be in 07/10/07 place to assess all risks to an individual resident. These must be regularly reviewed to take account of any changes in the residents’ condition and to minimise any identified risk. (The pervious timescale of 30/05/07 had not been met.) Deep-seated recliner chairs must 01/10/07 only be used in exceptional circumstances when this has been risk assessed and justified in the resident’s care plan, to DS0000006711.V335569.R01.S.doc Version 5.2 Flixton Manor Page 26 5. OP10 12(4)(a) reduce the potential of unreasonable or unnecessary restraint to individuals. Appropriate arrangements must be put in place for staff to support residents at mealtimes in a dignified manner. All medication must be stored safely and securely at all times to make sure that residents’ health is not at risk. Medication must be administered to residents exactly as prescribed by the doctor at all times to ensure their health and well being is not at risk. Records regarding medication must be clear and accurate at all times in order to ensure that residents are administered the correct doses of medication. A system of renewal, maintenance and re-decoration, including resident’s bedrooms and the communal kitchen area, must be in place to ensure they are well decorated, equipped and free from the risk of infection. Suitable sluicing facilities must be provided to reduce the risk of cross infection. The home must have appropriate and suitable management arrangements to ensure the health and welfare of the residents are promoted and protected. The application for registration of the manager must be made to the Commission. (The previous timescale of 30/05/07 had not been met.) Notifications of death, illness or other events must be forwarded to the Commission to ensure the home is regulated for the protection of the people accommodated. DS0000006711.V335569.R01.S.doc 28/09/07 6. OP9 13(2) 14/10/07 7. OP24 23 19/10/07 8. 9. OP26 OP31 23 18(1) 30/10/07 19/10/07 10. OP37 37 19/10/07 Flixton Manor Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose should include information about the staffing structure of the home and how the service provides for the needs of people with dementia; so prospective residents and their families are better informed. Staff should ensure the fingernails of the people living at the home are kept clean and at a comfortable length for them. The day’s menu should be readily available to all residents each day. The temperature of the lounge/dining room should be monitored to ensure it is at a comfortable temperature for the residents and staff. Entries in daily records should be clear and consistent. The medication policies and procedures should be reviewed and updated so that clear information is provided for staff and to ensure residents are not placed at risk. Risk assessments should be done for residents who self administer their medication or who keep their medication in their room. An system to audit medication and to assess the quality of medication handling should be established and maintained by the manager, to ensure that the quality of medication handling is assured and residents’ health is not at risk. An action plan should be provided to show the programme of renewal, maintenance and decoration, including resident’s bedrooms and the communal kitchen area, to ensure they are well decorated, equipped and free from the risk of infection. 2. 3. 4. 5. 6. 7. 8. OP8 OP16 OP24 OP7 OP9 OP9 OP9 9. OP24 Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Flixton Manor DS0000006711.V335569.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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