Inspection on 06/03/07 for Honiton Manor

This inspection was carried out on 6th March 2007.

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

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

Other inspections for this house

Honiton Manor 09/12/09

Honiton Manor 19/10/09

Honiton Manor 03/11/08

Honiton Manor 07/11/07

Honiton Manor 07/06/06

Honiton Manor 16/12/05

Similar services:

Manor Lodge

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Honiton Manor Honiton Manor Exeter Rd Honiton Devon EX14 1AL Lead Inspector Teresa Anderson Unannounced Key Inspection 6th March 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Honiton Manor Address Honiton Manor Exeter Rd Honiton Devon EX14 1AL 01404 45204 01404 45324 honitonmanor@aol.com oakdash@aol.com Mrs Angela Martha Christina Baker Mrs Sarah Jane Mary Dennis, Mr Howard Norman Dennis, Mr David Malcolm Baker Gillian Sarah Mary Berry Care Home 22 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) Category(ies) of Old age, not falling within any other category registration, with number (22) of places Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th October 2006 Brief Description of the Service: Honiton Manor provides 24-hour nursing care for up to 22 service users who have needs relating to older people. The two-storey home is an older style building situated on the main road into, and quite close to, Honiton and the local amenities. It is on public transport routes. There are eleven single bedrooms and five double bedrooms situated on the ground and first floors. None of the bedrooms have ensuite toilet or shower facilities. A passenger lift and a wide staircase link the floors. Communal space is made up of a large lounge and a dining room, both on the ground floor. Outside there is currently no access to a garden or to a seating area. There is ample parking. Further information about this service, including CSCI reports, can be obtained direct from the home. Current charges range from £307.00 to £700.00 per week. These charges do not include items such as newspapers, toiletries, taxis etc. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the normal programme of inspection. It was undertaken by 2 inspectors between 10.00am and 5.00pm. During that time inspectors spoke with the owners, manager, deputy manager and 4 members of staff. They also spoke with or saw the majority of residents. Most of the residents have some form of communication difficulty which made in-depth conversations difficult. During this visit the care and accommodation offered to 6 residents was tracked. This helps us to understand the care and services offered to all residents and to understand their experiences. Prior to the site visit questionnaires were sent to 17 residents and 6 were returned; to 12 members of staff and 5 were returned; and to 9 health and social care professionals and 5 returned. Their feedback and comments have been included in this report. The manager also completed a questionnaire giving details of any changes to the home including information regarding policies, staffing, staff turnover, fees charged and staff training. The last key inspection took place in June 2006 when a number of issues of concern were raised with this service. In order to check progress an unannounced random inspection was undertaken in September when it was found that some progress had been made in relation to staffing. The commission have since met with the owners and agreed an action plan for improvement. AT this inspection the owners were asked to deal with a number of environmental issues immediately as they were posing a risk to residents. The owners have since responded to these. What the service does well: The information available about this home is comprehensive and residents and/or their families say this is really helpful. In addition prospective residents and their families can come and visit the home as many times as they like before making a decision to move in. Visitors are made very welcome and are offered refreshments. People make choices in their daily lives, for example choosing what clothes to wear, what time to get up and go to bed and where to eat their meals. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 6 Residents are offered a well balanced, nutrition and varied diet. Staff work hard to ensure that residents make choices about what they eat and this includes taking the time to ensure that residents understand the menu. Complaints are seen as part of the service improvement plan and residents say their views are listened to and acted upon. What has improved since the last inspection? What they could do better: Although all prospective residents have their needs assessed prior to moving in to the home, these are not carried out in depth and do not include the level of detail needed to meet residents needs. There are some improvement in care planning, however residents do not have their care planned in a way that co-ordinates their care or which ensures that consistently high standards of care can be delivered. In addition, further improvements are needed to meet residents social needs particularly in relation to meeting the needs of those people with communication difficulties such as dementia. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 7 Medications are generally well managed however individual practice in relation to not locking medicines away during the medication round is placing residents at risk. In addition the temperature of the room in which medicines are stored was very high last summer. This has not been reviewed and is likely to result again this summer in medicines being stored at a temperature higher than that recommended by the manufacturers. At meal times there is some delays in serving meals meaning that residents wait a long time and that those residents who sit together are not always able to eat together. In addition some residents are not being helped to maintain their skills or their independence as some staff are providing assistance with eating that is not always needed. Food is served with gravy and sauces already added and residents are only offered jams and marmalades suitable for diabetics. Staff do not always follow procedures in relation to safeguarding adults and are therefore potentially placing residents at risk. A number of safety issues are placing residents at risk. These include infection control issues, manual handling issues, the inappropriate use of bed rails, unrestricted windows, lack of information around who has or has not received fire drill training, fire doors not closing and the use of freestanding electric heaters which poses a fire risk. Inconsistent practices in relation to obtaining information about staff before they start work in potentially placing residents at risk. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Intermediate care is not offered in this home. Residents have good information about the home prior to making a decision to move in. The assessment process is adequate but would be further improved if it were more detailed so that staff fully understand the needs of residents. EVIDENCE: Since the last inspection the owners have produced a comprehensive guide to the home. This is made available to prospective residents and/or their supporters and is available in all bedrooms for the residents to refer to. In surveys residents say they had enough information about the home. One said Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 10 they had a complete tour of the home before they decided to move in and another said they visited unannounced on numerous occasions before deciding to move in. All residents move into the home on a 4 week trial basis and have a contract detailing the terms and conditions of occupancy. Although in surveys staff say they have enough information about the care needs of the residents, three assessments seen demonstrate that assessments lack depth and detail. All are recorded in a ‘tick box’ format. Although there is opportunity to add further detail this had not happened on the three seen. The owners report that the format used has recently been changed and anticipate that this will help the Registered Nurses, who carry out assessments, to identify needs more comprehensively. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. Although healthcare needs are being met and care is offered in a way to promote privacy and dignity, care planning is not well understood by staff. As a consequence residents are not benefiting from coordinated and consistently well-planned care. The systems for the administration of medication largely ensure service users medication needs are met safely. Individual practice however is placing residents at risk and medication is not always linked to planning residents’ care planning. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 12 Honiton Manor has a system of care planning which is relatively new to the home and to the staff. The system provides a good basis for recording information, including care needs, and for reviewing needs and changing the care provided based on these reviews. The inspectors looked at six care plans and found that, in general, they do not provide individualised plans for care, do not reflect changing needs and demonstrate a lack of understanding of care planning by some staff. One care plan seen was excellent in relation to planning personal care, meeting the preferences of the resident in relation to daily routine and in relation to documenting changes in behaviour. Another care plan recorded on a monthly basis for one year that no change should be made to any of the care to be delivered. This person developed a pressure sore 6 months later. The care plan does not demonstrate that any changes were made to the care delivered. Whilst there is no question that the correct care has been agreed (with a specialist tissue viability nurse) it is hard to see how staff are judging that this is being delivered consistently when these instructions are not written down. Record keeping does not allow staff to judge how well the care and treatment being delivered is working. Another care plan gives instructions on what a person with diabetes should eat for supper to help prevent their blood sugar dropping. Staff were not aware of these instructions and records show they are not being followed. One member of staff explained that this is because the instructions conflict with this person’s food preferences. This conflict had not been identified and alternative choices had not been arranged. On the whole records and discussion with staff show that the management of this person’s diabetes has improved since the last inspection. Another care plan contains information about episodes when the resident challenges the service. The intention of this is to identify any precursors to these challenges so that, as far as possible, these can be eliminated. Records show that the majority of challenges are linked to medication and personal care. The care plan has not been reviewed in line with this. Instructions for staff on what might prevent challenges are very general (using a pre-printed template) and are not specific to this person. This resident is prescribed medication that they frequently refuse. Although records of refusals are kept on the medication administration charts, links are not made to care planning. For example, no record is kept regarding the effects of these refusals. Staff say they think that one medication is actually unnecessary and had not noticed any negative effects following the refusal of another ‘mood’ medication. Staff had not recorded this, talked to the resident about it or reported this to the GP. Care plans contain assessments in relation to identifying moving and handling needs, nutritional needs, skin care needs and risk of falls. However, the care Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 13 plans seen do not always record the actions to be taken to overcome the risks identified or do not record them in sufficient detail. When actions to be taken are recorded, these are not always carried out. For example, one care plan stated that the resident should be moved two hourly. This person was not moved from their chair during this inspection. Staff have recently updated their training in meeting nutritional needs and records show that in general this is an area of care planning that has improved. Many care plans show that residents have put on weight over the last months. Records detailing residents likes and dislikes are excellent. Other care plans identify mental health needs associated with dementia. However, they do not identify how these mental health changes affect the resident or how the resident communicates. Some comments in daily records indicate a lack of understanding around dementia and of person centred care. Despite these shortcomings in planning care, residents’ healthcare needs are met. In surveys residents say that they always or usually get the care and support they need and that they always or usually get medical support when needed. One person said that the manager had quickly called the GP when they were unwell to prevent them getting any worse. There is evidence in records of referrals being made and advice being sought from specialist agencies. In questionnaires healthcare professionals who have patients at this home say that staff always or usually seek advice and act upon it and that residents health care needs are always or usually met by the service. Preventative healthcare is achieved through annual medication reviews, and visits from/to for example the chiropodist and optician. The owners have purchased a number of specialist beds for residents’ comfort and for those with nursing needs. On the whole the management of medication is considerably improved. All medications are clearly labelled and stored securely and safely. Records are kept of all medicines received into the home. A monthly audit system has recently been introduced and this has not identified any failings or staff training needs. General training is provided to all staff and this has recently included training in using an ‘insulin pen’. The room in which the medicines are stored was, on this occasion, cool. However, when this was inspected in the summer months the room was too hot for the storage of medications. As no changes have been made, this is likely to be a problem again. Medication records are in order and this includes staff recording the dose given when this is prescribed as a variable dose. Good records are kept of controlled drugs and these were found to be in order. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 14 However, during the inspection the unlocked drugs trolley was left unattended in the residents lounge for some minutes. There were about ten residents using the lounge, many of whom have degrees of confusion. It was noted at the last inspection that one resident was receiving their insulin into their abdomen in the busy dining room. This practice has now stopped and staff report that residents are taken to the privacy of their bedrooms when this needs to be done. Staff were observed knocking on bedroom doors before entering and keeping bedroom and bathroom doors closed when personal care is being given indicating that they respect resident’s rights to privacy and dignity. Staff say they are taught this early in their induction training. However, during a tour of the home, a large pile of mail addressed to a resident was found unopened and undelivered. Staff report that they used to give this to the resident but haven’t for a while. The resident who owns this mail has severe communication difficulties and the care plan did not document why this was happening or how this decision had been made. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. Links with the community and visitors are generally good, although opportunities to support and enrich some residents’ social lives could be improved. Support is, on the whole, offered in a way that promotes choice and flexibility. The meals offered provide choice, variety and meet nutritional needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys residents say that there are usually or sometimes activities arranged by the home that they can take part in. These include trips out on the local ‘charabang’, walks into town for coffee, craft sessions and games. All activities and social interactions are arranged by the activities co-ordinator who works 5 mornings per week. She recognises that many of the residents have needs relating to dementia, have differing attention spans and different Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 16 interests and needs. In order to meet these individual needs she spends some of her time on a one to one basis with residents. During the inspection many meaningful and important interactions were observed. One person was being encouraged to gently exercise with the activities co-ordinator and clearly really enjoyed this. Another person was seen to be chatting away with the activities co-ordinator, and again was really enjoying this. In addition the home has recently adopted two cats that residents clearly enjoy and the owners have bought fish and a tank for another resident to enjoy in their bedroom. However, it is not possible for the activities co-ordinator to meet the needs of all residents within the time allocated. The activities timetable indicates that most afternoons are designated for TV watching. However, although the television was turned on in the lounge during this inspection, it was difficult to see or watch as the room became quite noisy and busy. Each time the inspector entered the lounge the screen was obscured by objects such as cushions and a wheelchair for long periods of time. It was noted that at least ten residents spent the morning and afternoon in the lounge without moving. The care plan of one resident stated that they liked quiet places, especially as they had little hearing. This person spent all day in the noisy lounge. Although staff came in and out of the lounge and spent a little time singing ‘Happy Birthday’ and presenting a cake to a resident, there was little meaningful conversation or time spent with residents in the lounge. The way the home assesses people’s interests is not person centred. The form used offers choices of interests that can be ticked. This does not encourage staff to find out what each person liked to do in the past or would like to do now or how this can be achieved. Visitors to the home are welcomed at any (reasonable) time and are encouraged to visit with their relatives in private or in the lounge. Visitors report that they are often offered refreshments and always made welcome. Care plans show that people make choices in their daily lives. For example they wear the clothes they choose, they choose what time to go to bed and get up and choose where to eat their meals. It was however noted that in order to meet the dietary needs of residents who have diabetes all residents are only offered jams and sweeteners that are suitable for diabetics. It was also observed that sauces/gravy were served on meals and not as accompaniments meaning that residents were not able to make a choice about this. Two residents complained. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 17 In addition it is unclear how one resident made the decision to move rooms and to share their room. The care plan does not contain any documentation in relation to this. There was no evidence that consultation had taken place. This decision has not been reviewed although records show that this person has frightened his roommate with his behaviour. In surveys residents say they always or usually like the meals at the home. One comments that the food is ‘consistently excellent and plentiful’. In order to help residents to make appropriate choices someone takes the time everyday to explain the choices available and to help them make a decision. Menus show that there is a good range of food offered which is sourced locally and cooked on the premises. Staff report that since the staffing has increased around supper time that they are better able to assist those who need it with eating at this time. During lunch it was noted that some staff may be over helpful in providing assistance to some residents. This may result in those who are able to feed themselves losing this skill or being embarrassed by receiving help they do not need. Although the lunch served was hot and well presented it was 30 minutes late, during which time residents sat and waited. When it came, residents were served one by one which meant that residents sitting together could not eat together. The manager explained that this is because the heated food trolley does not fit into the new dining room. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. The home has a satisfactory complaints system with evidence that resident’s views are listened to and acted upon. Residents feel safe and well cared for. Staff knowledge in relation to adult protection is good but good practice is not always being followed and may potentially place some residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has received and investigated four complaints within the set timescale of 28 days. One was substantiated and three were partially substantiated. These include 2 complaints received by the commission which the home were asked to investigate. Since the last inspection the way that the home deals with complaints has improved. Discussions with staff demonstrate that they now more fully share the owners’ opinion that complaints help to improve the service. Each care plan has a form upon which complaints, the investigation and any actions taken are documented. These are collected together so that they can be analysed, themes identified, the service reviewed and actions taken accordingly. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 19 The complaints policy is given to all residents and is clearly displayed in the hall. In surveys respondents say they always or usually know who to speak to if they are not happy and know how to make a complaint. Residents say they feel safe and are comfortable in the company of staff. The majority of staff have now received training in safeguarding adults and those spoken with demonstrate a good knowledge of this. However, the appearance of bruising on one resident’s hand (although not an uncommon occurrence in older people) was not documented sufficiently well and not investigated or reviewed appropriately. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 and 26. Quality in this outcome area is poor. The home has been improved in many areas but is potentially unsafe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is bright and airy. Many physical changes have been made enhancing the general feel of the home and making it more homely. A reception area has been added to the hall so that staff are more easily accessible and records are more accessible to staff. The lounge has been rearranged so that there are more intimate seating areas for residents to use. Many areas of the home have been redecorated and some re-carpeted. A number of divan beds have been replaced with specialist nursing beds. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 21 The home has a maintenance man to whom faults are reported and who takes prompt action. However, a significant number of issues were identified. At the last two inspections the home has been required to ensure that the two ramped areas in the home are safe. These areas also pose a challenge to the home in terms of promoting residents independence . One area has a steep rubberised ramp. This is very steep and the rubber is not completely flat presenting a trip hazard. The person who has a bedroom beyond this area uses a wheelchair. Staff are required to pull and push the wheelchair over this area presenting considerable risk to themselves. One member of staff says they do this on their own because they believe it is safer. In the other ramped area a moveable ramp lies over two steps. Again staff are requiring to pull and push wheelchairs up and down this ramp at considerable risk to themselves and contrary to good practice in moving and handling. In addition the wheels of the chair have to be precisely aligned to the ramp to prevent the wheelchair and the person in it from toppling over. The owners of the home were required to start to address this and some other safety issues within 30 days. They have been advised to request an Occupational Therapist to assess the home. Bed rails used on some residents’ bed are risk assessed and these are reviewed. However, these assessments are not identifying apparent risks stating there are ‘no abnormalities’ even though the bed rail clearly does not fit the bed and gaps are posing substantial risks to some residents. Two upstairs window openings were sufficient for a person to climb out of. These should be restricted to prevent accidents. The owners say that they had opened them and forgot to put the restrictors back on. Some radiators are not covered and, in the absence of thermostatic valves, it is unclear how the surface temperature is being kept cool to prevent scalding. One owner thought that the boiler temperature had been turned down (which would mean that the hot water is not controlled for Legionella’s Disease). They have agreed to check this. There is a freestanding electric radiator being used in the dining room which poses a fire risk. One fire door, which had a sticker on it saying it must be kept locked, was unlocked and another fire door did not close properly. Records in relation to fire drills were incomplete and without considerable effort it could not be determined who had not received this training. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 22 The machine used to dispose of soiled incontinence pads is not working properly. This means that only one pad can be macerated at a time. The preinspection questionnaire completed by the manager indicates that 14 people are incontinent of urine and 9 are incontinent of faeces. Although alternative arrangements are in place for collecting and disposing of these pads, three soaked pads were found on top of a collection bin in the sluice. A mat in one bedroom was extremely frayed posing a potential trip hazard to the resident whose room this is, and to staff. During this inspection the home was found to be generally clean although some wheelchairs and some residents slippers do need attention. The halls were largely obstacle free although disposable urine bottles are being stored on an upstairs landing. In one survey returned by a resident they report that sometimes staff leave cleaning materials and laundry bags in the corridors making it difficult for them to get around and posing potential trip hazards. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. Staff have the qualities and skills and receive appropriate and sufficient training to provide residents with the support and care they need. The recruitment procedures designed to protect residents are not being adhered to and are potentially placing residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys the majority of residents say that staff are usually available when they need them. One person said that they sometimes have to wait’ but this is understandable’. During the inspection call bells were answered promptly. In surveys staff say they feel well supported and that they are not asked to care for anyone outside their area of expertise. They say they are receiving supervision and records show that staff are receiving annual appraisals. Training for staff is well co-ordinated and has increased considerably. 6 members of the staff team have recently completed National Vocational Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 24 Qualification (NVQ) training in care. This shows a real commitment to ensuring that staff have the skills they need to care and to meet the needs of a wide range of people. Although this is not a home for people with dementia some residents have this condition. In recognition of this staff are receiving training in how to care for people with dementia. There are usually 3 members of care staff, a support worker and a Registered Nurse on duty in the morning, 3 care staff and a Registered Nurse on in the afternoon and evening and 1 carer and a Registered Nurse on duty at night. In addition the manager is often supernumerary and there is a cook, kitchen assistant, domestic and activities co-ordinator on duty at different times of the day. Since the last key inspection the owners have increased the number of staff on duty in the evening. This has helped to ensure that residents get the help they need at this time to eat their suppers. Three staff recruitment files were inspected. One did not contain a police check carried out by the home but had been carried out during a previous employment which potentially places residents at risk. In addition one file did not contain the employment history of the member of staff. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. Quality in this outcome area is adequate. Although there have been improvements in many areas of this service, the poor management of safety issues and lack of progress in relation to care planning is placing residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection many improvements have been made in to the services offered to residents. This has taken a real team effort and commitment. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 26 Discussions with staff demonstrate that the owners’ ethos of running the home in the best interests of residents is better understood and that staff feel that they are well supported and trained to do this. The management team have worked hard to develop a strong team and to ensure that people understand their roles and can fulfil these. They have worked hard to ensure that requirements set at the last key inspection are addressed. Although they have not been entirely successful in meeting these requirements there is clear evidence that progress is being made. The home does not deal with resident’s monies but has an invoicing and receipt system in place which resident’s advocates or relatives manage. There is a good quality assurance system in place. This includes residents, friends, relatives and health professionals’ satisfaction surveys. A satisfaction survey is currently being undertaken, the results of which the owners have arranged to have analysed independently. Two of the owners (who are registered nurses) visit the home two to three times weekly. However, these are not formalised or recorded as required by the commission when they are working with the home to bring about improvements. The service has worked hard to ensure that all staff receive mandatory training including moving and handling, first aid, food hygiene, fire safety and infection control. One Registered Nurse is now a Manual Handling Trainer and there is an appointed first aider on each shift. However, training in moving and handling will not equip staff to move residents across the two ramped areas identified in the ‘Environment’ section of this report. Two pairs of scissors were found around the home and in places potentially accessible to residents and perhaps vulnerable visitors. Some staff are not following infection control training/guidance as shown by the wet incontinence pads left on top of the collection bin and the sluice macerator is not working properly. Confidential information was found open to view in an unlocked office. Other significant environmental health and safety issues were detailed in the section of this report dealing with the environment. The home were required to deal with the majority of these issues within 30 days. They responded immediately and send an action plan to the commission. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 27 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 3 3 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 1 x x x x x 2 1 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x 2 1 Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 (1) (2) Requirement Each person living at the care home must have a plan of care that identifies all their individual needs and which offers instructions for staff on how these needs should be met in a consistent way. You must ensure that each plan is reviewed so that changing needs are identified and appropriate actions to be taken are recorded and their effects reviewed. Previous timescales of 31/08/06 and 30/10/06 not met. All medicines in the home must be kept safely and securely at all times. Each resident must have their social needs and interests identified and you must make arrangements to enable these needs to be met. Previous timescale of 30/10/06 partially met. In order to protect residents DS0000065696.V327401.R01.S.doc Timescale for action 31/05/07 2. 3. OP9 OP12 13 (2) 16 (2) (m) (n) 09/04/07 30/05/07 4. OP18 13 (6) 31/03/07 Page 29 Honiton Manor Version 5.2 from abuse you must ensure that all unexplained incidents and/or injuries are recorded and appropriately investigated. Previous timescale of 31/03/07 partially met. Risks to residents who live here must be identified and 05/04/07 eliminated or reduced as far as possible. On this occasion this includes: • Making sure that risk assessments carried out when considering using bed rails are comprehensive. • Making sure that the bed rails used are designed to fit the bed they are attached to. • Removing frayed rugs which residents or staff may trip over. • Ensure that upstairs windows have restricted openings to prevent accidental falls. • Those radiators that pose a risk of scalding to residents should be covered. • Scissors, or any sharp instrument, should be kept safely. • Substances and liquids likely to be harmful should be kept locked away at all times. • The free standing electric heater in the dining room should be removed to reduce the risk of fire. It is required that the above issues were dealt with within 30 days. Previous timescales of Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 30 5. OP19 13 (4) 6. OP19 23 (4) 31/10/06 and 31/03/07 partially met. All fire doors must close and be kept closed to ensure that any outbreak of fire is contained to one area. It is required that the above issues were dealt with within 30 days. The providers must ensure that all staff have received fire drill training and that his is recorded. The physical design of the two ramped areas of the home should be such that residents identified needs can be met. Suitable adaptations may need to be made and equipment provided to achieve this. The providers should take advise from a qualified Occupational Therapist. The temperature at which hot water is circulated through the heating system should not be reduced to prevent scalding as this means that controls in place to prevent Legionella’s disease are compromised. Residents must be protected from harm from cross infection from poor hygiene techniques. This means that used continence pads should be disposed of appropriately. Residents must be protected from potential harm through robust recruitment procedures. This includes ensuring that all staff have police checks undertaken by the employer and that employment histories are taken to ensure there are no unexplained gaps. Previous timescale of 31/10/06 not met. 05/04/07 7. 8. OP19 OP22 23 (4) 23 (2) (a) (n) 30/04/07 31/05/07 9. OP25 13 (4) 13/04/07 10. OP26 16 (2) (j) (k) 13/04/07 11. OP29 19 (1) 13/04/07 Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 31 12. OP37 17 (1) (b) All information relating to residents should be kept securely and in line with Data Protection within the home. It is required that the above issues were dealt with within 30 days. The providers must visit the home at least once monthly on an unannounced basis. They must do this so that they can form an opinion as to the standard of care provided in the home. They must record their findings and send these to the commission after each visit. The two ramped areas in the home must be comprehensively risk assessed and appropriate actions taken to reduce or eliminate the risks presented by these areas. It is required that the above issues were dealt with within 30 days. 05/04/07 13. OP38 26 (2) (3) (4) (5) 13/04/07 14. OP38 13 (4) 05/04/07 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 OP3 OP7 Good Practice Recommendations Each prospective resident should have a comprehensive assessment prior to moving into the home which identifies their needs and how these needs are to be met. Each residents care plan should include their previous and current interests and their social care needs so that these needs and preferences can be met in an individualised way. Any resident who has a pressure sore should have the treatment to be used recorded in their care plan. The outcome of this treatment should be recorded and actions DS0000065696.V327401.R01.S.doc Version 5.2 Page 32 3. OP8 Honiton Manor 4. OP8 5. OP8 6. 7. 8. OP9 OP10 OP14 9. 10. 11. OP15 OP15 OP26 taken accordingly. Those residents who have mental health needs should have these needs recorded and, where needed, actions should be taken to identify and prevent those situations that result in the resident challenging the service. Each resident who is identified as being at risk of falls should have a plan of action as to how the risk identified will be minimised to help prevent falls or to help reduce the harm done by falling. The temperature of the room where medicines are kept should be maintained at a level that ensures that medicines will be stored at the correct temperature. All residents should receive their mail. If this cannot happen, the decision should be made by the multidisciplinary team and the reasons should be recorded. Residents should be assisted to make choices in their daily lives. On this occasion this includes making sure that residents choose whether or not to only have jam suitable for diabetics. Where residents are not able to communicate their decisions, they should receive the help they need to make decisions and how this was achieved should be recorded. Residents should only receive as much help as they need with eating to ensure that they maintain their independence. People sitting together at tables for their meals should have their meals served at the same time so that these occasions are social. Residents’ slippers and wheelchairs should be cleaned for hygiene reasons as well as to maintain their dignity. Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Honiton Manor DS0000065696.V327401.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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