Inspection on 24/07/09 for Guisborough Manor

This inspection was carried out on 24th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Guisborough Manor 16/02/09

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 18/02/2010.

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:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Valerie Daly     Date: 2 4 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Guisborough Manor Woodhouse Triangle Middlesbrough Road 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: St Martins Care Ltd care home 63 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 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 Care Homes for Older People Page 4 of 25 Over 65 0 63 63 0 1 6 0 2 2 0 0 9 Brief description of the care home ample assisted baths and showers available. There are various communal lounge and dining areas located throughout the home. Car parking facilities are available. There are numerous shops, pubs, restaurants and churches in the nearby town centre. The weekly fees are from £477.32 to £512.54 Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means people who use this service experience adequate quality outcomes. This Key Inspection was to check that the home meets the standards that the Care Quality Commission say are the most important for the people who use the service, and that it does what the Care Standards regulations say it must. The inspection was conducted by one regulatory inspector and a pharmacy inspector in one inspection day. During the inspection a number of records were looked at, including records of people who use the service, along with staff recruitment and training records and maintenance. There was also discussion with the manager and care staff who work at Guisborough Manor. Care Homes for Older People Page 6 of 25 The manager had completed the Annual Quality Assurance Assessment (AQAA), the services self-assessment of how well they think they are meeting the standards. We have reviewed our practice when making requirements to improve national consistency. Some regulations from previous reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 25 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 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgment has been made from evidence gathered before and during a visit to this service. People have their needs assessed prior to admission, ensuring their needs can be met. Evidence: The care files of four people who use the service were examined, two of which were for the people most recently admitted to the home. In each file there was a copy of the assessment carried out by the home, which was completed prior to people being admitted to the home. There was sufficient information to determine if peoples needs were able to be met by the home. there was also a copy of the local authority/care managers assessment, which detailed care needs. People spoken to confirmed that they or their families had visited prior to moving into Guisborough Manor. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments need to be devolped further. Medication systems needs to be strengthened Evidence: Four care files were examined. There was a care plan in place where a need had been identified in the assessment. Since the previous inspection the care plans had been developed further and they contained more information about the whole person. However all information regarding activities is kept together in one file, not separately in individual care plans. The four care files examined did not have any activities documented. Evaluations were carried out monthly and there was evidence in one of the files to show that changes to the plan had been made. There seemed to be a lot of duplication of information within the home. For example a persons care file is kept in the office. The information is then photocopied and kept on the unit where the person lives. Entries made then have to be duplicated. Whilst care records show that a daily record is made there is the need to develop these further so that they contain more value based information about the person and the care Care Homes for Older People Page 12 of 25 Evidence: provided. Currently the records contain comments such as dignity maintained, food given, washed and dressed. Good interaction was observed between the staff and people living at the home. There is a good detailed policy in the home covering all aspects of medicine management. This means staff have access to up to date information on legal requirements and guidance. The arrangements for ordering, receiving and disposal of medication are adequate but further improvements could be made. Help should be sought from the PCT if there are difficulties in obtaining prescriptions from surgeries leaving people without medication. Two members of staff are available to administer medicines on each floor this limits interruptions. Medicines are store securely in locked drug cupboards or trolleys. A system is in place to add the date of opening to liquids and those medicines with limited use once opened.This helps to make sure medication is safe to administer when needed. The temperature of the storage areas, including the fridge, is recorded regularly so that staff know medicines are being stored at temperatures recommended by the manufacturer. The controlled drugs cupboards appears to meet safe custody requirements. The controlled drugs registers are suitable for use and entries are legible and complete. MAR chart folders had a divider with photographs and allergies recorded this reduces the risk that people are given the wrong medication. There were very few gaps found on the MAR charts. This means that there is a good record kept of people receiving their medication as prescribed. However there were some inconsistencies in handwritten entries on the MAR charts. Handwritten entries and changes to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. Records show that people were refusing medication or missing evening doses regularly some action had been taken but not followed up. Information on medication in care plans was mostly brief and not specific or up to date. A person on anticoagulation medication had some information in care plan but this was incomplete. There were some documentation for people who were self administering medication but not all had completed assessments. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have choices in their daily lives as much as is possible. Good contact is maintained between the people who live in the home, relatives and friends. A varied diet is provided. Evidence: The home employs an activity co-ordinator who spends time with the people who use the service on both floors. There are a variety of activities available such as quizzes, pamper days, bingo, memory lane, chair mobility, sing a longs. The home have also held a tea party and money raised was for the Marie Curie Charity. There is also regular entertainment in the home. Following an activity a detailed account is made by the activity co-ordinator, who joined in, if they enjoyed it or not. However this information is not included in peoples care plans. Three people spoken to during the inspection said how much they enjoyed the activities. One person said the activity person is very helpful, she tries to keep everyone happy. A person commented in a survey the residents who prefer to spend time in their rooms should be given social stimulation, half hour game of cards, conversation etc. Two relatives interviewed said they can visit at any time and are always made welcome. One person interviewed said its a very nice place, the girls are all very Care Homes for Older People Page 14 of 25 Evidence: nice, I get up when I like, I can always ring the bell and ask for a cup ot tea, I enjoy reading and the activities. The menus showed that a variety of food is offered to the people who use the service and more alternatives are available. Information regarding peoples likes and dislikes of food and any special diet is part of the assessment process prior to the person moving into the home. People spoken to said that the food is well cooked and tasty and there is always something that they like. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience 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 this service are able to express their concerns and have access to a robust complaints procedure, are protected from abuse, and have their rights protected. Evidence: The home has a complaints policy and procedure in place. This had been updated to include the name and address of the funding authorities/local authorities. There had been one complaint made since the previous inspection. Records showed that this had been investigated and the complainant was satisfied with the outcome. Three people living at the home said they would talk to the manager or another member of staff if they had a concern. The home has a whistle blowing policy and procedure in place. Since the previous inspection this had been updated to include the contact details of the Social Services Departments . There was evidence in the staff training information to show that staff had received training in safeguarding people and this is also included in induction training. During interviews with staff they confirmed they had received training and were able to to discuss the procedure to follow in the case of suspected abuse. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical layout of the home enables people who use the service to live in a well maintained and comfortable environment. Evidence: A tour of the home was carried out. All areas of the home are decorated and furnished to a high standard. There are numerous communal areas for people to sit, giving choices of a quiet place to chat, read, listen to music or watch television. Bedrooms contained personal items, some people having brought items of furniture along with photographs, ornaments and pictures. Where bedrooms directly overlooked the car park people had been asked if they would like some net curtains or blinds at their windows. There are a choice of bathrooms and showers available for people to use and equipment is available to assist them if they require it. On the day of the inspection the home was very clean and odour free. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. Evidence: The home has a rota in place, which shows a skill mix of staff being on duty on each shift. The home has a policy and procedure in place for the recruitment of staff. Four staff files examined showed that the required information, references and Criminal Record Bureau checks were in place prior to staff commencing work in the home. Since the previous inspection staff had undertaken training in, Fire Safety, First Aid, Moving and Handling, Food Hygiene, Health and Safety, COSSH, Dementia Awareness, Challenging Behaviour, Nutrition, Adult Protection and Nutrition. At the time of the inspection thirty nine carers were employed. thirty had completed NVQ level 2 or above. This is more than the 50 required which is very good. From discussion with staff and looking at completed surveys it seems that the staffing levels on the ground floor unit should be kept under review. At the time of the inspection quite a lot of the people who required assistance from either one or two Care Homes for Older People Page 18 of 25 Evidence: members of staff. There is also duplicate paperwork for staff to complete, which takes time away from the people living in the home. One person commented in a survey, the caring is good and the staff are very helpful, I am very happy with the home. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff work as a team. People who use the service are protected by the health and safety policies and procedures. Evidence: The manager is competent and experienced to run the home. Staff, people who use the service and two relatives all said the manager is approachable along with the deputy and senior staff. One person commented in a survey the management are very accommodating and the staff are good, I compliment the management and staff on their obvious dedication. The home has a quality assurance system in place. The manager said that questionnaires will be sent out to District Nurses, other professional bodies and people who use the service when the home has been open for a year. The results will be examined and any comments/suggestions will be taken on board for improvement of the service. The area manager completes a regulation 26 visit monthly. An inspection of the premises both internal and external is carried out and various records are Care Homes for Older People Page 20 of 25 Evidence: viewed. The recent reports from the regulation 26 visits were viewed. In the last visit carried out the area manager spoke to one member of staff and one person living in the home to seek their views. Health and Safety and complaints documentation were viewed and an inspection of the premises took place. The manager also carries out regular audits covering many areas of the home and service provided. A random selection of personal allowances were checked. The systems used for looking after peoples monies are good. Receipts are kept when any money is spent on behalf of the person. A number of health and safety documents were examined at the inspection, including hot water temperatures, fire tests, emergency lighting tests. Records showed that whilst fire drills are carried out every three months, this has just been for staff and people who use the service have not been included. The manager said that at the next fire drill, people living in the home in that particular area of testing would be included. Hot water temperatures for wash hand basins, showers and baths were found to be too cold. Minimum temperature being 33 degrees Celsius to a maximum of 37 degrees. Checks were carried out monthly. However for health and safety guidance, where people are immersed in water the temperature should be checked and recorded weekly. The home has a formal supervision system in place. There was evidence to show that staff received supervision regularly. This was also confirmed by staff during interviews. A selection of policies and procedures were looked at. They had been reviewed and updated since the previous inspection. Care Homes for Older People Page 21 of 25 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 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 4 Hot water temperatures in wash hand basins, showers and baths must be close to 43 degrees Celsius. This is required for the health and safety of the people who use the service. 21/09/2009 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 7 Daily records need to be developed further so that they contain more value based information about the person and the care provided. All information about an individual should be kept together in the care file. This will help in understanding the whole person and their life in the home. Handwritten entries on MAR charts must be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. The prescriber should be asked to provide information when medication has a dose as directed or when required. 2 7 3 9 Care Homes for Older People Page 23 of 25 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 This makes sure that the medication is given correctly. 4 38 Where a person is immersed in water the temperature should be taken and recorded weekly. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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