Inspection on 16/02/09 for Guisborough Manor

This inspection was carried out on 16th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Guisborough Manor 24/07/09

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Guisborough Manor Woodhouse Triangle Middlesbrough Road Guisborough Redcar & Cleveland TS14 6QU     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Lowther     Date: 1 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Guisborough Manor Middlesbrough Road Woodhouse Triangle Guisborough Redcar & Cleveland TS14 6QU 01915652294 01915652303 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : St Martins Care Ltd care home 63 Number of places (if applicable): Under 65 Over 65 0 63 dementia old age, not falling within any other category Additional conditions: 63 0 The maximum number of users who can be accommodated is 63 The registered person may provide the following category of service only: Care Home only - Code PC To service users of the folowing gender: Either Whos primary care needs on admission to the home are within the followng categories: Old age not falling within any other category - Code OP, maximum number of places, 63 Dementia - Code DE, maximum number of places, 63 Date of last inspection Brief description of the care home Guisborough Manor is a new purpose built home located on the outskirts of Guisborough. It is registered to accomodate sixty three people who or have dementia or require help with personal care only. Currently the people who require personal care live on the ground floor and people with dementia on the first floor. The first floor is accessed by a passenger lift. All of the rooms are single and have en suite toilet and washbasin facilities. There are ample assisted baths and showers available. There are various communal lounge and Care Homes for Older People Page 4 of 29 Brief description of the care home dining areas located throughout the home. Car parking facilities are available. There are numerous shops, pubs, restaurants and churches in the nearby town centre. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This is the first time the home has been inspected since it was registered. This unannounced inspection took place on 16th February 2009. The purpose of the inspection was check that the home meets the standards that the Commission for Social Care Inspection consider are the most important for the people who use the service. Time was spent reviewing records, speaking to members of staff, the people who live in the home, visitors to the home and to the manager. Time was also spent walking Care Homes for Older People Page 6 of 29 around the home and observing interactions between staff and the people who live in the home. The company supplied some information prior to the inspection on a form called an AQAA. This is an annual quality assurance assessment for the company to provide information about their service. Information was also received from people who use the service and their relatives. The fees charged at the time of this inspection were between 443 pounds and 94 pence and 488 pounds and 13 pence. This does not include the cost of hairdressing, chiropody, personal toiletries and newspapers. What the care home does well: What has improved since the last inspection? What they could do better: Care plans must be updated immediately when it is identified that a need has changed. This is to make sure that staff know how to look after people on an individual basis. All medication must be administered as prescribed and available to administer from. Accurate records must be kept for all medicines including controlled drugs. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. A current photograph of each person should be attached to their MAR chart. This helps reduce the risk of medication been given to the wrong person. Handwritten entries and changes to MAR charts must be accurately recorded and detailed. This makes sure that the correct information is recorded so that a person receives their medication as prescribed. The temperature of the medication room should be regularly monitored. This makes sure that medicines are been stored at the temperature recommended by the manufacturers. Robust adult protection procedures must be put in place. This is to protect the people who live in the home from risk of harm. The complaint procedure needs to be updated to include the contact details of the local authority. This is to make sure that people are aware of the other agencies who can help them with their complaint. The Registered Person should consider the use of blinds or nets in the ground floor bedrooms which are immediately in front of the car park. This is to ensure privacy for the people who live in those rooms. Staffing levels should remain under review to make sure appropriate numbers are on duty to meet the needs of the people who live in the home. The policies and procedures must be reviewed and updated. They must be reflective of the service and provide people with the information they need. This is to ensure the Care Homes for Older People Page 8 of 29 safety, wellbeing and protection of people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs were assessed before moving to the home and they were assured those needs would be met. Evidence: The files of four people living at the home were looked at. Two files from the ground floor unit and two files from the first floor unit. One of the files was for a person who had recently been admitted to the home. In all of the files there was a copy of the homes own pre admission assessment and for those people who were being supported with the funding, there was also a copy of the care management assessment. The homes own assessment covered a number of areas of need and were completed in sufficient detail. People spoken with confirmed that they were involved in the admission process and had been given sufficient information. Care Homes for Older People Page 11 of 29 Evidence: The home does not provide intermediate care therefore assessment of Standard 6 is not required. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receiving the service are happy with the way in which care is delivered by staff. However records detailing how health and personal care is to be delivered and associated risks need more detail and information. The way in which medication is managed is inadequate and could put people using the service at risk. Evidence: Four sets of care records were reviewed. The assessment covered a range of areas from interests, personal care, mental health, areas of risk and there was also a pen portrait about the individual person. In all of the files, the assessment had been completed and written in a person centred way. There was discussion with the manager about expanding the level of information within the assessment so that they were not just need focused, that they actually contained more information about the whole person. The monthly evaluation of care is taking place, however this was not always being acted on. For example one person was identified as having lost weight. That person Care Homes for Older People Page 13 of 29 Evidence: was also refusing his/her nutritional supplements, but the evaluation did not reflect what action had been taken. In another case the monthly evaluation confirmed that a need had changed, but the actual care plan was not updated. Whilst generic risk assessments are in place covering areas such as, bathing and showering, there is the need to develop more individual, needs specific risk assessments and corresponding care plan. Currently no actual screening tools are being used within the home for areas such as nutrition or skin integrity although everyone has a care plan for these areas. People who were spoken with were very positive about the staff and the way in which they were being supported and cared for. A pharmacy inspector carried out the medication aspect of this inspection. It was found that Medication Policies were general and not specific to practice within this home. The policy on self medication assessment was unclear. Medication is stored in a very small cupboard on each floor. Storage for medicines was secure, however on the 1st floor the room was warm and there were gaps in the temperature records. Dates of opening was recorded on eye drops,ointments and liquids. Where the dividers between MAR charts are completed they are very good with allergies listed however there are 15 dividers with no photo or other information listed on the 1st floor and 9 dividers with no photo or information on the ground floor. Handwritten entries were not checked and signed and in some instances were not accurate. Handwritten entries on MAR charts should be sufficiently clear and detailed so that other staff can follow the changes correctly. There were some gaps and not all medication was accurately recorded when an audit was undertaken. Where the dosage of a medication has changed the date of change was not recorded or countersigned and in some cases the old dosage remained on the container. Medication received into the home when a new person is admitted should be accurately recorded and checked and all staff should be aware of unusual dosages at hand over. Where a person is regularly refusing medication or prescribed nutritional supplements this shoud be referred to the presciber so that any appropriate action can be taken. There was a small controlled drugs cupboard on both floors. The cupboards appeared to meet regulations. No discrepancies were found in the controlled drugs records on the 1st floor. On the ground floor controlled drugs records were not accurate and there were controlled drug stock quantities which did not balance with the stock available Care Homes for Older People Page 14 of 29 Evidence: one of which could not be resolved on the day of the visit. Records of controlled drugs administration made in the controlled drugs record book did not correspond with records of administration on the MAR chart. The arrangements for ordering, receiving and disposal of medication are adequate. However on the day of visit some medication was unavailable for administration because the home was waiting for prescriptions. Controlled drugs received into the home was not accurately recorded in the controlled drugs register. The morning medication round was observed on the first floor. During the medication round a no touch process was used. Whilst people confirmed that privacy and dignity is maintained, there is an issue with the privacy of some of the bedroom windows on the ground floor. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have opportunities to take part in activities. They are supported to live in a flexible environment where there is choice of routines and independence. The food provided is of a good quality and meets the dietary and cultural needs of the people who use the service. Evidence: Most of the people said that activities are suitable. One to one activities take place as well as group activities. Regular activities include card and board games, bingo and arts and crafts. Outside entertainers visit on a regular basis and a church service is held once per month. People are also taken out. Relatives said that they could visit at any time and that they are always made welcome. People said that they have a choice about how they like to spend their day. They can also choose what time to get up and go to bed and when they would like to have a shower or bath. The lunch and evening meals were observed. The tables were nicely set with tablecloths and condiments. Staff who were helping people were doing this in a Care Homes for Older People Page 16 of 29 Evidence: discreet and dignified manner. People all said that they liked the meals. One said, This is a five star facility as far as food is concerned. Another said, The food is good and you get a choice. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to raise concerns and the complaints procedure is available within the home. However the policies and procedures for safeguarding adults do not give clear staff guidance about what they should do if they receive an alert. Evidence: The AQAA detailed that there had been one complaint since registration. This was investigated by the home. There was a copy of the complaints procedure on display in the main reception. The actual complaints procedure needs to be updated, as it did not contain the detail of the funding authorities/local authorities. People spoken to said that they had no complaints. They said if they did they would have no hesitation about raising these with the staff or the manager. There were cards in reception from relatives thanking the staff for the care provided. There was a copy of the Teeswide protocols for the Protection of Vulnerable Adults, No Secrets. The whistleblowing policy did not contain details about who to contact if they wished to raise a concern. The contact details or telephone number needs to be included. It was also agreed that it would be useful for staff to have some further updating in respect of the correct procedures to follow and where to obtain the contact information. Some staff who were spoken to said that they had completed No Secrets training. The CSCI are aware of two issues which were dealt with by the manager Care Homes for Older People Page 18 of 29 Evidence: which should have been referred through safeguarding procedures. These have since been reviewed by Redcar and Cleveland local authority who have confirmed that the action taken by the manager was appropriate. The manager is aware that she must refer such issues in future. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a safe and very well maintained environment in which to live. The home was clean, well decorated and extremely homely. Evidence: The main entrance is located to the front with adequate parking and level access to the home. Accommodation is on two floors. Currently the ground floor is used for people with residential care needs and the upper floor for people with dementia. There are a number of lounges and dining areas located throughout the home. All of the bedrooms have an en suite toilet and washbasin. However in some of the en suites the height of the mirror was not at an appropriate height. In addition some of the ground floor bedrooms are directly in front of the car park and have no blinds or other means of ensuring privacy for people when the curtains are open. These issues were discussed with the manager at the time of the inspection. During a tour of the building the inspector saw that many of the rooms are decorated to the persons own taste and there was evidence to confirm that people can take in some personal items when they go to live there. This includes pieces of furniture as well as photographs and ornaments. A high standard of decor and furniture is provided throughout the home. One person said, I love this room and the communal areas are of a very high standard. Care Homes for Older People Page 20 of 29 Evidence: There are ample bathrooms and showers throughout the home. There was a range of equipment seen around the home to support people with bathing and mobility. The inspector found the building to be clean, tidy and free from offensive odours. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are appropriately recruited and in sufficient numbers to meet the needs of the people who live in the home. Evidence: From the rota supplied at the inspection there was sufficient care staff on duty to meet the assessed care needs of the people who were using the service. People said that staff were usually around and answered the call bells quickly. One person said, The staff come quickly when I need them. However staff said that they sometimes feel that they are very busy on the dementia unit. The staffing levels on this unit should be kept under review. The home had staff files in place, which provided evidence that the appointment of a new staff member is in the main made through proper recruitment processes. This includes the vetting of staff through the use of references, POVA first checks and Criminal Record Bureau (CRB) checks. From the information on the AQAA almost 50 of staff had obtained an NVQ Level 2 in care or above. In discussion with the manager it was confirmed that several more members of staff had commenced the course. Recent training has taken place in adult protection, health and safety, dementia awareness and record keeping. All staff have Care Homes for Older People Page 22 of 29 Evidence: received the required mandatory training. Staff said that they are also supported with regard to personal training needs. People were very positive about the staff, their attitude, approach and how they were cared for. One person said, Most of the staff are wonderful. I love them, they are really helpful. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the required qualification and experience to manage. A number of systems need to be developed further to ensure health and safety is promoted and that the home is operating in the best interests of people living and working there. Evidence: The manager is registered with CSCI and has the required experience, knowledge and skill to manage the home. People living at the home and visitors who were spoken to during the inspection confirmed that the manager is approachable and that they would go to her if they had any concerns. There was evidence in staff files to show that supervision was taking place and that the staff were being appraised. Staff confirmed that supervision takes place on a regular basis. The system for managing personal allowances was looked at. Signatures are obtained Care Homes for Older People Page 24 of 29 Evidence: and receipts are kept. The area manager completes a regulation 26 visit monthly. This is an audit which covers all aspects of the environment and the care delivered. The manager said that during this audit staff, the people who live in the home and visitors are consulted about their views. Any suggestions made are considered and improvements made where possible. The manager also carries out regular audits covering all environmental and care aspects which may result in improvements being made. Fire drills are being carried out on a regular basis. Weekly fire checks are taking place and water temperatures are being checked and recorded. The policies and procedures were looked at. However some of the policies were company generic policies and were not specific to the home. There was no actual flow to them and some were difficult to find. As they currently are, they do not readily provide the staff with the guidance needed to ensure they are operating in a way that ensure the safety and wellbeing of people living at the home. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be updated immediately when it is identified that a need has changed. This is to make sure that staff know how to look after people on an individual basis. 31/03/2009 2 9 13 All medication must be 31/03/2009 administered as prescribed and available to administer from. Accurate records must be kept for all medicines including controlled drugs. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. 3 18 13 Robust adult protection procedures must be put in place. 14/04/2009 Care Homes for Older People Page 27 of 29 This is to protect the people who live in the home from risk of harm. 4 38 12 The policies and procedures must be reviewed and updated. They must be reflective of the service and provide people with the information they need. This is to ensure the safety, wellbeing and protection of people. 01/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The temperature of the medication room should be regularly monitored. This makes sure that medicines are been stored at the temperature recommended by the manufacturers. A current photograph of each person should be attached to their MAR chart. This helps reduce the risk of medication been given to the wrong person. A current photograph of each person should be attached to their MAR chart. This helps reduce the risk of medication been given to the wrong person. Handwritten entries and changes to MAR charts must be accurately recorded and detailed. This makes sure that the correct information is recorded so that a person receives their medication as prescribed. The complaint procedure needs to be updated to include the contact details of the local authority. This is to make sure that people are aware of the other agencies who can help them with their complaint. The Registered Person should consider the use of blinds or nets in the ground floor bedrooms which are immediately in front of the car park. This is to ensure privacy for the people who live in those rooms. 2 9 3 9 4 9 5 16 6 24 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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