Inspection on 23/07/08 for Forest Manor Nursing Home

This inspection was carried out on 23rd July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Forest Manor Nursing Home 11/05/09

Forest Manor Nursing Home 20/06/07

Forest Manor Nursing Home 10/05/06

Forest Manor Nursing Home 14/10/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Forest Manor Nursing Home Mansfield Road Sutton In Ashfield Nottinghamshire NG17 4HG Lead Inspector Rose Moffatt Unannounced Inspection 23rd July 2008 09:30 X10029.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 Forest Manor Nursing Home DS0000063840.V368888.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 and Care Homes for Adults 18 – 65*. 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. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Manor Nursing Home Address Mansfield Road Sutton In Ashfield Nottinghamshire NG17 4HG 01623 442999 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) Hallmark Healthcare (Sutton in Ashfield) Ltd Vacancy Care Home with nursing 40 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (40), Physical disability (40) of places Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Persons may provide the following categories of service only: Care Home with Nursing - Code N to service users of the following gender: either whose primary care needs on admission are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE Physical Disability - Code PD The maximum number of service users who can be accommodated is 40 2. Date of last inspection 20th June 2007 Brief Description of the Service: Forest Manor Nursing Home provides personal and nursing care to older people, people with a physical disability and people with dementia. The home is situated between the town centres of Mansfield and Sutton in Ashfield. The home has a well-maintained patio and garden area and car parking space. There are three lounges and a spacious dining room. The home has 36 single bedrooms and 2 shared bedrooms. None of the bedrooms have en-suite facilities. People who need wheelchairs to get around can access all areas within Forest Manor. Mobility aids are available such as hoists, transfer belts and strategically placed handrails. A wheelchair accessible shower and bath area is available. A vertical lift is also available to allow easy access to the first floor of the home. Information about the home, including CSCI inspection reports, is available in the main entrance area of the home, or from the acting manager. The fees currently charged range from £294 to £529 per week. There is an extra charge for hairdressing and podiatry services. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 5 Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of our inspections is on outcomes for people who live in the home, and their views on the service provided. The inspection process looks at the provider’s ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • Surveys returned to us by people using the service and from other people with an interest in the service. • Information we have about how the service has managed any complaints. • What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. • The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. • Relevant information from other organisations. • What other people have told us about the service. We carried out an unannounced inspection visit that took place over 8.5 hours on 1 day. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 37 people accommodated in the home on the day of the inspection visit, including 17 people assessed as needing nursing care. People who live in the home, visitors and staff were spoken with during the visit. The acting manager was available and helpful throughout the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. ‘Case tracking’ was used during the inspection visit to look at the quality of care received by people living in the home. Four people were selected and the Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 7 quality of the care they received was assessed by speaking to them and /or their relatives, observation, reading their records, and talking to staff. The registered manager for the home had left in June 2008. The previous deputy manager for the home, Mrs Betty Jackson, was appointed as acting manager on 21st July 2008. What the service does well: What has improved since the last inspection? What they could do better: There could be a more person centred approach to care planning so that people are more involved and receive care and support in the way they prefer and expect. People could be better protected by ensuring staff have the relevant training and ensuring that correct procedures are always followed if abuse is alleged or suspected. Also, by ensuring a fully robust recruitment procedure. People’s needs could be better met if there were always sufficient staff on duty, particularly during the late evening and night time. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 8 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. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 (Older People) 1 and 2 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient information about the home was available and there was a satisfactory needs assessment process so that people were confident the home was able to meet their needs. EVIDENCE: The acting manager said the Statement of Purpose for the home was not available as a new version was in preparation. The Service User Guide was available in each bedroom and also in the main entrance area of the home. People spoken with were aware of the Service User Guide. Some information Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 11 in the Service User Guide was out of date and there were no details about end of life care. Six people who live in the home returned our surveys and, of these, five said they had been given enough information about the home and one said they had not. Three relatives of people living in the home returned our surveys and one said they have always had the information they need about the home, and two said they usually did. We looked at the records of four people. All the records seen included assessment information completed by social services and / or hospital staff, and a pre-admission assessment by the home. Further assessments had been completed when the person came to live in the home. Assessment information had been reviewed monthly. All six people who returned our surveys said they always received the care and support they needed. Of the three relatives who returned our surveys, one said the person’s needs were always met at the home and two said the needs were usually met. People spoken with said their needs were met at the home. One person was pleased that staff had received appropriate training about their medical condition so that their specific needs could be met. A visitor said their relative was “well cared for”. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 (Older People) 6, 9, 16, 18, 19 and 20(Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care and support provided was generally satisfactory to meet the needs of people living there. However, care plans focused on problem areas, rather than a person centred approach to ensure people’s needs were fully met in a holistic way. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 13 EVIDENCE: All six people who returned our surveys said they always received the care and support they needed, including medical support. Of the three relatives who returned our surveys, one said the person’s needs were always met at the home and two said the needs were usually met. One relative spoken with after the inspection visit said their relative’s needs were not met at the home. People spoken with during the inspection visit were mostly satisfied that their needs were met at the home. Six staff returned our surveys and all said that they had received training that helped them to meet people’s needs. We received information in January, March and July 2008 with concerns about standards of care at the home. We asked the providers to investigate the concerns on two occasions. They told us they found no evidence to substantiate the information. We used the information received and the provider’s response in planning and carrying out the inspection. The four records seen all included care plans. All the care plans seen had been reviewed monthly up to date. The care plans had details of the action required by staff to meet the assessed needs of the person. The care plans were not written in a person centred way. One person did not have a care plan to address their nutritional needs. The care plans had been signed by the person, or their relative / representative, to indicate their involvement and agreement. Some people spoken with were aware of their care plans and said they were involved in care reviews. From observation during the inspection visit, people’s needs appeared mostly to be met. Staff were observed to respond promptly and appropriately to requests for help. At lunchtime, one person was observed to slip down in their chair several times and was repositioned on one occasion by manually lifting under their arms by a care assistant. Also at lunchtime, a person who needed help with eating and drinking was fed by a care assistant who stood throughout, rather than sitting with the person. The Annual Quality Assurance Assessment (AQAA) identified that the home could improve by providing “more person centred care”. The acting manager was also aware of this and said the providers were about to introduce new person centred care planning documentation, and staff training to support this. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 14 The care records included details of visits and treatment by healthcare professionals, such as GP, District Nurse, chiropodist and optician. People were referred appropriately for specialist help, such as Speech and Language Therapist and dietician. Assessments were carried out of the person’s risk of developing pressure sores and appropriate action taken to reduce the risk. The assessments were reviewed and updated monthly. People said staff treated them with respect and maintained their privacy and dignity. People said that staff were “patient”, “kind”, “wonderful”, “always bright and friendly to everyone”. One person said, “The staff know the residents well, treat them with respect and keep them really clean and well cared for”, and, “ the staff deal very well with different needs of the people”. Staff were observed to knock on bedroom doors before entering and to speak to people in an appropriate and respectful way. Some residents showed spontaneous affection to staff. The Service User Guide gave details of the range of care needs provided for at the home, but did not include any details about end of life care. The staff had received training about the Liverpool Care Pathway, a protocol for providing appropriate care and support for people at the end of their lives. The acting manager had experience of using the Liverpool Care Pathway. She said there were no people currently in the home who met the criteria for using it. Three of the care records seen included brief details of the person’s wishes for when they died, the fourth one had not been completed. Medication was handled separately for people needing nursing care and those needing personal care only. The qualified nurses at the home dealt with the medication for people needing nursing care and the senior care assistants dealt with medication for other people at the home. The senior care assistants had received in house training and competency assessments, and were due to receive external training from a pharmacist in September 2008. Medication was stored securely. Medication administration records were mostly correctly completed. One record seen had handwritten instructions with no signature of the person who had written them, and no second signature to indicate that someone else had checked the instructions were correct. The record for a person having a variable, ‘as required’, dose of Paracetamol did not always show the dose given. There were records of the receipt and disposal of medication. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and15 (Older People) 12, 13, 15 and 17 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a good range of activities offered and links with the local community so that the lifestyle in the home generally met the preferences and expectations of people living there. Although people were generally satisfied with the meals, some lapses in providing choice and maintaining dignity could affect their enjoyment. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 16 EVIDENCE: All six people who returned our surveys said there were always activities they could take part in. A relative who returned one of our surveys said people were encouraged to join in with activities, and “I’m so happy that the home has its own pets and allows relatives to take in their pets”. This person commented that the home could improve by providing more exercise for people living there. In response to our survey question asking if the home met the different needs of people, one relative said always and two said usually. The AQAA said that the home had improved in the last twelve months by providing newsletters and more entertainment. The AQAA said the home could improve by providing more activities and more trips out. People we spoke with during the inspection visit were pleased with the range of activities offered. Three people were pleased they were involved in gardening at the home. One person pointed out the hanging baskets and the raised planted beds in the garden that they had helped with. People said they had enjoyed a visiting entertainer. There were photographs on display of recent activities. The home employed an activities organiser working for around 20 hours per week. The activities organiser had been in post for about four months and was enthusiastic about the role. The range of activities included games, quizzes, visiting entertainers, film afternoons, baking, and exercise to music. There was a computer with internet access for the use of people living in the home. The planned activities for the week were displayed in the main entrance area and in the corridor next to the dining room. There was a regular church service at the home. The activities organiser produced a regular newsletter for people living in the home and visitors. There were meetings for people living in the home and their relatives / representatives. At a recent meeting, people had volunteered to take on responsibilities at the home. For example, one person had taken on the job of watering the garden, and another was responsible for sweeping the patio area. People had expressed an interest in writing to people in other care homes – a ‘pen-pal’ scheme – and the activities organiser planned to arrange this. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 17 The activities organiser planned to encourage more community involvement by asking the local school to help with the home’s summer fair, inviting a local dance school to put on a performance in the home, and using a local newspaper to publicise events at the home. There were several visitors in the home during the inspection visit. They said they were made welcome and could visit at any reasonable time. One visitor was pleased that they could make themselves and their relative a drink at any time. People spoken with said they could see their visitors in private if they wanted to. Of the six people who returned our surveys, two said they always liked the meals, three said usually, and one said never. People said, “the meals are good”, “the food is good – and plenty of it”, “could do with providing a menu over a month so I can pick my meals”, “not a big enough diabetic menu”. One person said they enjoyed the meals, but was sometimes hungry in between. A visitor said they had shared meals with their relative at the home and had enjoyed them. The dining room was bright and spacious with French doors opening onto the patio and garden. There were fresh flowers and tablecloths on each of the tables. There was a table with jug flasks of hot water, tea, coffee, milk and sugar left out so that people or their visitors could make a drink whenever they wanted to without having to ask staff. The menu for the day was displayed. The dining chairs did not have ‘sliders’ on the bottom of the legs to make moving people into and away from the table easier. Meals were served in two sittings to ensure that there were enough staff to help people with eating and drinking. People who needed help were served at the first sitting. Staff were observed helping people appropriately, such as encouraging and prompting people who could feed themselves, and feeding people who could not. One person was observed to slip down in their chair several times and was repositioned on one occasion by manually lifting under their arms by a care assistant. One person was fed their meal by a care assistant who stood up throughout, rather than sitting with the person. For people who could not feed themselves, the main meal was served in a dish, rather than a plate, and the contents were mixed together by staff before giving to the person, so that it would be difficult for the person to differentiate flavours and textures. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 18 The second sitting was busier and noisier as there were more people. People were asked about their choice of vegetables and puddings. Adapted cutlery and plates were available as needed. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 (Older People) 22 and 23 (Adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were generally satisfied that their complaints were dealt with promptly and appropriately. People were put at risk by deficiencies in practice and in staff training about safeguarding vulnerable adults. EVIDENCE: The six people who responded to our surveys said they knew how to make a complaint. People spoken with during the inspection visit said they knew how to make a complaint. A copy of the Service User Guide was provided in each bedroom and this included the complaints procedure. The six staff who responded to our surveys said they knew what to do if anyone had concerns about the home. Staff spoken with said they would report any concerns to senior staff, though not all were sure where to find the complaints procedure. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 20 The complaints records seen showed that complaints were dealt with promptly and the outcome and any action taken was documented. Two of the relatives who responded to our surveys said the home had responded appropriately when concerns had been raised, one said they had not had to raise any concerns. People spoken with said concerns raised had been dealt with effectively. We received one direct complaint in January 2008, and a copy of a complaint that had been made directly to the providers in March 2008. Both complaints were about poor standards of care, cleanliness and bad odours. We asked the providers to investigate the complaint made in January 2008 and to let us know the outcome of their investigation into the complaint made in March 2008. For both complaints, the providers found that there was no evidence to substantiate the claims made. In July 2008, we received information about two complaints that had been raised directly with the home. In both cases, the person had received a response from the home, but was not entirely satisfied with this. The AQAA said the home could improve by monitoring complaints more closely, including informal complaints. The six people who responded to our surveys all said they knew who to speak to if they were unhappy. People spoken with said they would go to staff with any concerns and were confident that action would be taken. Not all staff had received training about safeguarding vulnerable adults. Staff were aware of safeguarding issues and said they would report any concerns to senior staff. Some staff were not aware of procedures that senior staff and management should follow to ensure any allegations of abuse were properly investigated. We received notifications of two incidents at the home, (as required under Regulation 37). Both incidents included issues that were potentially about safeguarding vulnerable adults, but had not been referred to social services by the home as required. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 (Older People) 24 and 30 (Adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was clean and suitably equipped so that people lived in a safe environment that generally met their needs. EVIDENCE: Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 22 The home was modern and purpose built. There were two shared bedrooms, though the acting manager said only one was in use by a married couple. None of the bedrooms had en-suite facilities. People spoken with were pleased with their bedrooms. One person was pleased they could have the furniture, pictures and photographs they wanted, and said, “its custom made for me”. One person was pleased with the view of the garden from their bedroom. The home appeared to have suitable equipment to meet people’s needs, such as a lift to the first floor, lifting hoists, a shower trolley, adapted baths, and handrails in the corridors and toilets. The main entrance area was bright and welcoming with fresh flowers, information about the home, and photographs of staff. The lounges were comfortably furnished. The dining room was spacious. The home was in need of general refurbishment and redecoration throughout. For instance, the décor in the corridors was drab and dingy; one of the ground floor bathrooms had cracked tiles around the bath and the floor was badly marked with holes in places – this bathroom was not used as there was no hoist or other aid to help people in and out of the bath; several of the toilets had wooden seats that looked tatty, dated, and difficult to ensure they were thoroughly clean; in many areas the paintwork was scuffed and peeling. An additional office had been created in what had previously been a toilet. The acting manager was not sure if this had been approved by the local fire service. The garden was very well maintained and was accessible for people in wheelchairs. There were raised beds so that people in wheelchairs could help with gardening if they wanted to. People said they enjoyed using the garden. There was an area with a shelter that staff used for smoking, but this did not appear to meet the smoke-free regulations introduced in 2007. The acting manager was already aware of this and said there were plans to remove the shelter. The six people who returned out surveys said the home was always fresh and clean. People spoken with during the inspection visit said the home was usually clean with no offensive odours. The home was clean and free from offensive odours on the day of the inspection visit. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 23 The home had two sluice rooms, one on each floor and both with a mechanical sluice. Staff were seen to use disposable gloves and aprons for helping with personal care. Staff also used disposable aprons when helping at lunchtime. The AQAA said that out of a total of 32 staff, 17 had received training about infection control. The home had sought advice and support to ensure correct procedures were followed when caring for a person infected with clostridium difficle. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 (Older People) 32, 34 and 35 (Adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and staff training were sufficient to meet the basic needs of people living in the home, but not enough to ensure a holistic, person centred approach to their care and support. EVIDENCE: Four of the people who returned our surveys said that staff were always available when needed, two said staff were usually available. One of the staff who returned our surveys said there were always enough staff available, two said there usually were, and 3 said there sometimes were. Staff commented that the home could be improved by “more staff” and said, “we have not had Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 25 enough staff on duty for a long time, very concerning and very stressful to staff on duty”, and, “need an extra carer on at night because all care cannot be met during the night”. A relative said, “I think the staff are in need of extra help as the home at the moment is full and they seem to be run off their feet”. The staff rota showed that there were usually five care assistants from 8am to 8pm, plus a nurse, and two care assistants for the night shift from 8pm to 8am with a nurse. Care staff were supported by kitchen, laundry and domestic staff during the day. The acting manager’s hours were supernumerary and there was a part-time administrator. During the inspection visit there appeared to be sufficient staff around during the day to ensure people’s needs were met. The night staff came on duty at 8pm when people living in the home were still up and about. It was noted in the care plans of some people that they should be encouraged not to go to bed before 8pm as this ensured a better night’s sleep and a more ‘normal’ routine, particularly for people with dementia. Staff told us that it was difficult for night staff to meet people’s needs properly with current staffing levels. The acting manager was aware of staff concerns and said it had been discussed with the area manager and that a solution might be to have an additional senior care assistant working the night shift. Staff told us that it could be difficult to cover for staff who were off sick, and also that staff sickness had not been well managed in the past. There were times when they had to work short-staffed because of sickness. We looked at the records of three staff, all recruited since the last inspection. One record included all the required information and documents. One record had one written reference instead of two and there were gaps and inconsistencies in the person’s employment history. Another record also had gaps in the employment history. Two of the relatives who returned our surveys said staff always had the right skills and experience to meet people’s needs, one relative said staff usually did. The six staff who responded to our surveys said the training they received covered people’s needs and kept them up to date. People told us the staff were “lovely”, “friendly”, “very caring” and “patient”, “we have a laugh with them”, and “ nothing is too much trouble for them”. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 26 Staff told us that communication between staff could be improved as sometimes care assistants were not fully informed about the changing needs of people living in the home. The AQAA said that the induction training at the home met Skills For Care standards. However, we found this was not the case, although the acting manager said a review of induction training was currently taking place. The AQAA said that nine out of twenty care assistants (45 ) had already achieved National Vocational Qualification (NVQ) at Level 2 or above and that four were working towards the qualification. Staff training records showed that most staff were up to date with the required statutory training. Some staff had received training in dementia awareness. Training was planned about dementia awareness, equality and diversity, person centred care, and the Mental Capacity Act. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 28 31, 33, 35 and 38 (Older People) 37, 39 and 42(Adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home was generally well managed, there were some deficiencies in practice and staff training so that people were not fully protected. EVIDENCE: The registered manager for the home had left in June 2008 and the deputy manager had taken on the role of acting manager, though did not have any supernumerary time to carry out management tasks. She was formally appointed from 21st July 2008, working full time, supernumerary hours from that date. She had therefore only been in post for two days on the day of the inspection visit and was getting to grips with the responsibilities of the role. The acting manager had already started working towards the Registered Manager’s Award and said she intended to apply for registration with CSCI. People told us they had confidence in the acting manager to act on any concerns raised. Staff told us they found the acting manager easy to get on with and “well organised”. One member of staff said, “The support I have received has been really good”. One person said they felt that a “more strict” approach was needed and hoped the acting manager would be able to “make sure staff do their jobs properly” and “sort out staff sickness”. The AQAA was completed by the previous manager. The self-assessment section was very brief and gave little information about the home. There was minimal evidence to support any of the claims made. The data set section was virtually fully completed, with just one question not answered. We found some inconsistencies during the inspection visit with the information given in the data set section of the AQAA. We received notifications of two incidents at the home, (as required under Regulation 37). Both incidents included issues that were potentially about safeguarding vulnerable adults, but had not been referred to social services by the home as required. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 29 The quality assurance system included meetings for people living in the home and their relatives / representatives and monthly internal audits by the acting manager. The acting manager said the providers had recently introduced a new quality assurance team who would be visiting the home to carry out audits. The acting manager was not sure if the quality assurance system included surveys of people living in the home, their relatives / representatives, staff, and others involved in the home. Most people had some personal money held in the home. This was stored securely with access limited to the administrator and acting manager. Records and receipts were kept of all transactions. The records were audited by the acting manager as part of the monthly audit system. The AQAA said that equipment and systems had been maintained as required up to date. Satisfactory records were seen of accidents. Staff had received training about health and safety, such as manual handling, fire safety, and Control of Substances Hazardous to Health (COSHH) regulations. As noted in the Environment section of this report, the smoking shelter used by staff did not appear to comply with relevant regulations. The door to the lounge used for activities was wedged open. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 30 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 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 2 34 X 35 3 36 X 37 X 38 2 Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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 OP1 Regulation 4 and 5 Requirement The Statement of Purpose and Service User Guide must be reviewed to include up to date information and the range of needs the home can provide for. This will ensure that people have sufficient information to make decisions about living in the home. All staff must have training about safeguarding vulnerable adults, including the local multiagency procedures, to ensure that people are fully protected. There must be sufficient staff on duty to ensure that people’s needs can be fully met. All staff employed at the home must have the required documents and information in place, specifically, 2 written references and a full employment history with a written explanation of any gaps. This will ensure a robust recruitment procedure that protects people living in the home. All manual handling procedures must follow current regulations DS0000063840.V368888.R01.S.doc Timescale for action 31/08/08 2 OP18 13(6) 30/09/08 3 4 OP27 OP29 18(1)(a) 19(1)(b) 30/09/08 30/09/08 5 OP38 13(4)(b) (c) 31/08/08 Page 32 Forest Manor Nursing Home Version 5.2 6 OP38 23(4)(a) 7 OP38 23(4)(a) 8 OP38 13(4) and good practice guidance to ensure people are moved safely and correctly. Doors must not be wedged or 31/08/08 propped open. This will help to reduce the risks to people in the event of fire. The new office must meet fire 31/08/08 safety and building regulations to ensure people live in a safe environment. Any smoking shelter or smoking 30/09/08 room provided must meet the relevant regulations to ensure people live in a safe and pleasant environment. 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 OP9 Good Practice Recommendations Where there is a variable dose for medication, the exact dose given each time should be recorded on the medication administration record. This will ensure that people receive correct levels of medication. Meals for people who need a soft or liquidised diet should be presented with separate tastes, rather than all the food mixed together. This will uphold their dignity and make the meal more interesting and enjoyable. A plan for the refurbishment of the home should be drawn up in consultation with people living there and staff. This will ensure people are involved in choices about their environment. Dining chairs with sliders attached to the feet should be provided. This will help to ensure safer and easier moving of people at mealtimes. The staff induction programme should meet Skills For Care standards to ensure people are supported by competent and well trained staff. The quality assurance system should be further developed to ensure that people’s views and opinions are taken into consideration in relation to developments within the home. DS0000063840.V368888.R01.S.doc Version 5.2 Page 33 2 OP15 3 OP19 4 5 6 OP19 OP30 OP33 Forest Manor Nursing Home Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Forest Manor Nursing Home DS0000063840.V368888.R01.S.doc Version 5.2 Page 35 - 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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