CARE HOMES FOR OLDER PEOPLE
Honiton Manor Honiton Manor Exeter Rd Honiton Devon EX14 1AL Lead Inspector
Ms Rachel Fleet Unannounced Inspection 16th December 2005 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Honiton Manor Address Honiton Manor Exeter Rd Honiton Devon EX14 1AL 01404 45204 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) Ms Angela Martha Christina Baker Mrs Sarah Jane Mary Dennis, Mr Howard Norman Dennis, Mr David Malcolm Baker Gillian Sarah Mary Berry Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Honiton Manor (formerly known as Ernsborough Lodge, but now under new ownership) provides 24-hour nursing care, for up to 22 service users who are within the category of older people. The two-storey home is an older style building situated on a main road into Honiton, on public transport routes and having some car-parking space. There is a passenger lift between floors. The majority of bedrooms are for single occupancy only. A level-access shower room on the ground floor has an adapted sink for use by visiting hairdressers. There is currently one lounge-dining room for communal use, but such facilities are being improved by creation of a separate dining room. The new owners have commenced a year-long programme to improve the home both environmentally and regarding care-related systems (documentation, staff skill mix, etc.). The owners own two other residential care homes. Ms Baker and Mrs Dennis are registered nurses, and they occasionally work as part of the care team at Honiton Manor. Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection of the home since it was registered, with new owners, as ‘Honiton Manor’. The inspector visited for six hours, meeting with all twelve residents around the home, seven of whom gave their views in depth. All had been admitted for long-term nursing care. She also spoke with relatives for two residents, as well as with two visiting professionals and three care staff. Care documentation and other records were examined. Standards that were met at the last inspection have not been re-inspected on this visit. This report should therefore be read along with the last report, for fuller information. What the service does well: What has improved since the last inspection?
Building work was in progress to create a separate, new dining room. Vacant bedrooms were being redecorated. Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 6 A new, bigger office was also being created, providing somewhere to speak with visitors or staff in private if necessary. Medication storage facilities have been improved. New armchairs, commodes and some kitchen equipment have been purchased. What they could do better: 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. Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4 There is currently insufficient written information available for prospective residents to help them make a fully informed choice about where to live. Provision of individual contracts (or statements of terms and conditions) with the home helps protect residents’ rights. Current systems for assessment of needs before admission help to ensure that the needs of those admitted to the home can be met. Action has been taken to ensure that the home can meet the needs of those admitted. EVIDENCE: The Statement of Purpose and Service User Guide are not yet updated to reflect the new ownership and associated changes. Care records included individuals’ copies of the home’s terms and conditions. These included the room to be occupied and fees. A new resident and their visiting spouse were very satisfied with the admission process and subsequent care they had experienced. The manager meets prospective residents, in their current care setting or when they visit the home to look around, to assess their care needs prior to their admission. This has not always been possible in the past (because of staffing arrangements), but is a
Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 9 positive development since the new ownership. Care documentation for one new resident also included a needs assessment from the previous carers (another registered service). Another had the care manager’s shared assessment. Recent training had included some topics identified at the last inspection as necessary. Residents said staff were competent and knew their care needs, etc. when they came to help them. The home does not offer any specialised services. Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&8 Care plans, whilst including residents’ health and personal needs, do not fully inform staff of residents’ social needs, thus these needs may not be addressed. Insufficient detail in care plans regarding some health or nursing needs creates the risk that residents’ health will not be promoted as fully as possible. EVIDENCE: Bedbound frailer residents looked cared for, and confirmed they felt comfortable. A resident and a relative felt staff were observant of health needs and acted if problems arose. One resident did not appear as well cared for as others. Staff said they were looking into particular needs of this resident. Some ‘personal profiles’ still recorded only the resident’s current level of activity or interests, rather than seeking to find out interests they may have had when in better health. Two residents said they got bored but couldn’t think what they would like to do with their time. A wound care matter was being followed up by the home’s ‘link nurse’ i.e. the nurse with a particular interest and responsibilities for wound care at the home. Risk of pressure sores was regularly monitored using an assessment tool. The new owners are going to purchase weighing scales. Care records for residents with nutritional needs such as diabetes or difficulties feeding
Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 11 themselves did not include nutritional assessments or reference to intake. The care plan for a diabetic did not include sufficient detail to clearly guide staff about that individual’s care needs (the blood glucose range to be maintained, for example, and other information as indicated in local Primary Care Trust guidance). Monthly reviews did not include evaluations of the effectiveness of the planned care. For example, how successfully continence had been promoted, or blood glucose levels maintained within normal limits. Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 14 The lifestyle of the home matches the preferences of some residents but not all – recreational and religious interests of some residents are not satisfied, although action is being taken to address this. Residents benefit from being enabled to exercise choice and control over their lives. EVIDENCE: A resident in their room said they preferred to remain there, but staff still kept them informed of organised group activities and entertainments. Various musical events had been arranged around Christmas time, which residents said they had enjoyed. Staff said recent dementia care training had included learning about suitable activities. The care plan for a resident did not include meeting their religious needs, although it was recorded that they had an active faith. Two residents said they got bored occasionally. The new owners are recruiting an activities staff for 18 hours/week. Residents said staff were respectful, and offered them sufficient choice during daily life at the home – regarding food, where to spend their time, etc. Bedrooms were personalised with residents’ own furniture and possessions. Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Good efforts have been made to ensure residents are protected from abuse. Additional considerations relating to use of bedrails would further protect individuals’ rights. EVIDENCE: Action had recently been taken by the home to address safeguarding issues, contacting external professionals appropriately. Staff training on safeguarding of adults had taken place in the week prior to the inspection, one staff spoken with confirming they had attended this and found it useful. A new staff had not yet attended training, but recalled relevant questions asked as part of their job interview. Call bells had been left within residents’ reach. Consent forms for bedrails were seen, but care plans and risk assessments did not include the use of bedrails, why necessary, alternatives considered, time limits, etc. Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 24 Communal areas are in need refurbishment and development, but action is being taken to improve facilities and provide a more pleasant, bettermaintained environment. Some residents’ choice regarding having their own possessions with them is limited by lack of private lockable facilities. EVIDENCE: Residents were satisfied with their personal accommodation and standards of cleanliness. The new owners have an initial year’s programme for renewals and refurbishment of the property (internally and externally), since various areas would be improved by redecoration and new fittings - bathrooms and the kitchen, for example; the lounge is to be decorated in the near future, and new armchairs have been obtained. Security arrangements have been reviewed, with new arrangements evident. A new dining room was being created. The owners assured the inspector that relevant fire; planning and building authorities had been appropriately consulted prior to this work commencing.
Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 15 A lockable space is not yet provided in all bedrooms, even where refurbishment has taken place. The home looked clean, although odours were noted in two rooms. The new owners intend to purchase a carpet cleaner for the home. Although a new staff hadn’t yet had formal training on infection control, they were able to describe appropriate action to take to reduce cross-infection risks. Alginate bags and the sluice cycle on the washing machine were used, rather than hand-rinsing soiled laundry. Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 & 30 Whilst new staff are enabled to acquire basic care skills, residents would benefit daily and in the longer term if more staff had skills developed to a nationally recognised standard. EVIDENCE: Two care staff have an NVQ2 in care. A new staff spoken with was going to undertake an NVQ2 in the new year, along with five other colleagues. There is a nurse on duty each shift. Residents were very positive about the staff, including that they were kind and polite. One felt they were rushed. Another said staff said they were shortstaffed but still managed to pop in regularly. A visitor said staff answered the phone quickly if they rang the home, met with them if they visited, and always knew how residents were. There is a written programme of induction. A new staff member said they had shadowed colleagues before working more independently. The training programme for January 2006 included dementia (to meet the needs of current residents) and skin care. Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 37 & 38 Residents benefit from the management style and commitment of the registered manager. Quality assurance processes need formalising and development, to promote the longer-term welfare of residents. Aspects of health and safety must be addressed, including appropriate notification of developments at the home, to ensure the welfare of residents and staff. EVIDENCE: Residents said they saw the manager regularly, that she was approachable, and acted on suggestions. Visitors to the home (including the professionals spoken with) were positive about the home, and had no issues about how it was run. One commented that the manager had provided continuity at the home, having worked there some years. The manager has not obtained the
Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 18 Registered Managers Award, but has undertaken other relevant courses in past years, as well as recent updating (regarding safeguarding adults, for example). Two residents were concerned about aspects of the new ownership, and said they hadn’t met much with the new owners. Ms Baker and Mrs Dennis agreed with the inspector that they would spend time individually with every resident to discuss any concerns they might have. A relative said they had met the new owners, and were happy with the home. One staff was not clear about reporting of residents’ concerns in order to improve the home’s service. Care plans were stored securely. The Commission had not been informed about the internal building work taking place at the home (converting three bedrooms to a dining room). Fire safety checks hadn’t been recorded since September 2005, although an external engineer had serviced the systems in December 2005. The fire alarms were tested during the inspection. Fire training had taken place in September and October 2005. Fridge temperatures were being recorded weekly only, and had been above recommended levels. The fridge controls were altered immediately; medication kept here was removed to secure and more appropriate storage. Safety checks on bedrails were recorded. Ms Baker confirmed Legionella checks had been carried out as part of the purchase process when they acquired the home. Moveable and fixed hoists had been serviced within the previous six months. Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 3 X X X 2 X X STAFFING Standard No Score 27 X 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X 2 2 Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 20 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 Requirement Timescale for action 31/01/06 2 OP1 5 3 OP8 12(1)(a) You must compile in relation to the care home a written ‘statement of purpose’ which consists of the information listed under Regulation 4(1), & supply a copy to the Commission and make it available to service users & their representatives. You must compile in relation to 31/01/06 the care home a written guide to the care home – the ‘Service user’s guide’ - that includes the information listed under Regulation 5(1), supplying a copy to the Commission & each service user. You must ensure the home is 31/01/06 conducted so as to promote & make proper provision for the health and welfare of residents. This is especially regarding nutritional screening on a periodic basis (including maintaining a record of nutrition), care planned for residents with diabetes, and effective evaluation of care given. Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 21 4 OP38 39(h) You must give notice in writing to the Commission as soon as it is practicable to do so if it is proposed to significantly alter the premises of the care home. 31/01/06 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 2 Refer to Standard OP7 OP12 Good Practice Recommendations You should ensure each resident’s care plan includes their social care needs. You should ensure each resident has the opportunity to exercise their choice in relation to leisure interests and religious observance, to satisfy their recreational & religious needs. Where forms of restraint are used (lap belts or bedrails, for example), associated care plans & risk assessments should include why it is necessary, alternatives considered, guidance on timed use of the restraint, etc. You should implement the programme of renewal as agreed during the registration process. You should ensure each resident has lockable storage space in their bedroom, for medication, valuables, etc. You should ensure a minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2006, excluding the registered manager & registered nurses. You should develop effective quality assurance & quality monitoring systems, based on seeking the views of residents & other stakeholders. You should ensure you protect the safety & welfare of residents & staff by 1) Ensuring that fire safety checks are recorded at intervals recommended by the local fire authority. And 2) That fridge temperatures are recorded & maintained as recommended by the local Environmental Health officer. 3 OP18 4 5 6 OP19 OP24 OP28 7 8 OP33 OP38 Honiton Manor DS0000065696.V270909.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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