Inspection on 07/06/06 for Honiton Manor

This inspection was carried out on 7th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 06/03/07

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 Key Unannounced Inspection 7th June 2006 09:30 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.V293229.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.V293229.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 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) N/A 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 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th December 2005 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 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, on public transport routes. The home has ample car-parking spaces. Floors are linked by a passenger lift. The majority of bedrooms are single occupancy and are situated on the first floor. The home has a large lounge and a newly added dining room. The new owners have commenced a year-long programme to improve the layout and décor of the home. The owners own two other residential care homes. Ms Baker and Mrs Dennis occasionally work as part of the care team at Honiton Manor. Information about this service, including CSCI reports, is provided by the home by contacting them directly. As at June 2006, the fees charged range from £500.00 to £600.00 per week. Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place over two days and for a total of 13 hours. The manager completed a pre-inspection questionnaire. Surveys were sent to 16 residents and 7 were returned; they were sent to all (approximately 30) staff and 9 were returned; to 15 health and social care staff, including GPs, and 8 were returned. During the majority of this inspection the inspector concentrated on tracking the care, accommodation and services offered to three residents. She also looked at the care plans of two other residents. She spoke with other residents, with two visitors, with staff and with the owners, and she toured the building. What the service does well: Honiton Manor was taken over by new owners in November 2005. At that time a number of weaknesses were identified which the owners are working hard to rectify. In addition, they have identified areas they wish to improve and are introducing many new systems in order to achieve this. The home has a relaxed and informal atmosphere where staff are described as ‘kind’, ‘excellent’ and ‘good. A Registered Nurse is on duty both day and night and they report they receive adequate training and keep up to date with current practice. Visitors are warmly welcomed and say that staff are friendly and offer refreshments. One resident commented that she was very warmly welcomed when she first moved in. GP’s and Social Services care managers are extremely complimentary about the home, the staff and the care provided to residents. One said that some residents and relatives have been ‘overwhelming in their praise’. Bedrooms are personalised and all areas of the home are kept clean and hygienic. Medication systems are on the whole well managed. Meals offered are nutritious and varied and residents say they enjoy them. Descriptions include ‘magic’, ‘five star’ and ‘beautifully presented’. There is always a selection of fresh fruit and vegetables and the cook uses fresh produce wherever possible. Residents’ monies are not kept, as the home prefers to use a billing system. This is easily auditable. The home is clean throughout and the cleaners are much appreciated by the residents, not only for cleaning but also for running errands. Bedrooms are personalised. Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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.V293229.R01.S.doc Version 5.2 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.V293229.R01.S.doc Version 5.2 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 and 3. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The assessment process is adequate but would be further improved if it was more detailed so that staff fully understand each residents needs. Residents need more information regarding the home so that they are able to make an informed choice before moving in to the home. EVIDENCE: Residents, in surveys, say they have a contract and that they received enough information about the home on which to base their decision about moving in. The owners are currently redeveloping the statement of purpose and service users guide for use by prospective and current residents, so this is not yet available to them. Registered nurses undertake assessments of prospective residents but these lack depth. Information that is needed to ensure the needs of each individual resident can be met and to make the move into the home easier is not always taken. Although the policy in the home states that only the manager undertakes these assessments, staff explained that this is now a delegated Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 9 task and that training has yet to be provided. One resident who commented about moving into the home, said ‘what a welcome’. Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 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, 9 and 10. Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. There is a good new care planning process, the introduction of which is being well managed. When fully understood by staff this will help to ensure that residents needs are met. Whilst there is good access to local health professionals who value the service, some health care needs are not currently always met Some practices in relation to the management and administration of some medication are putting some residents at significant risk. Personal support is not always offered in such a way that does not always promote the privacy and dignity of residents. EVIDENCE: Residents living at Honiton Manor, on the whole, say they are happy with the care they receive. One said ‘I get full attention when not well’, another said this is a ‘very good service’ and another said ‘staff are caring and supportive’. Staff report they know what to do if a resident becomes unwell or if their needs change. Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 11 All surveys received from health and social care professionals stated they were happy with the care provided. Comments included ‘medication reviews take place regularly’, ‘staff are always courteous and helpful’ and ‘effective and caring’. All residents have a plan of care that is well organised and easy to access and understand. This system has been newly introduced and management are working hard to ensure that it will be fully understood and will have a meaningful input from all staff. This forms part of the plan for the development of the home. The deputy manager gave a beautiful description of person centred care and describes how she, and other staff, want to achieve this type of care for all residents. One care plan contained poor instructions and record keeping in relation to the management of a resident with diabetes, placing this resident at considerable risk. The home was advised to contact the Diabetes Specialist Nurse as a matter of urgency and this was done before the end of the first inspection day. One member of staff has received training in Diabetes Care. Some staff have signed to say they have read the guidelines issued by the Primary Care Trust (PCT) but this has not been translated into practice. Another care plan contained an entry in relation to a possible scalding incident. This had not been investigated and was not discussed with the relative. The owners have agreed to investigate this as a matter of urgency and will inform CSCI of the outcome and actions to be taken. A third care plan did not contain enough information to ensure that the nutritional needs of this person could be met. Staff were not aware how much this person had eaten that day or if she had had a cold drink (on this very hot day). Written records of the nutritional or fluid requirements or intake of residents are not kept. Although one member of staff has received training in using the recommended nutritional assessment tool, this has not been translated into practice within the home. The cook did not know the food preferences of the residents (this is a temporary cook as the permanent member of staff is currently on sick leave). Following supper on the first day of inspection, of the six trays seen which had been returned to the kitchen, five had significant amounts of food left on them. This was not been reported to the nurse or recorded anywhere. One tray also contained an untouched drink. Two visitors report that little supervision is given to those who need help with food at suppertime. None of the care plans seen had instructions for staff on how to promote continence or how often to change pads. The inspector saw little activity in relation to toileting throughout the day. The majority of residents seem to wear pads and some residents smelt of urine. One visitor said that staff had Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 12 told a resident that she did not need to go to the toilet when asked because she was wearing a pad. Another relative told the inspector that toileting does not always routinely happen. Care plans looked at did not contain adequate manual handling instructions. The inspector saw two carers helping one lady out of bed. The technique used raised significant concerns in relation to manual handling and training. This resident has also been found on the floor in her bedroom on numerous occasions. Although she was checked for injury, there is no evidence that any actions have been taken to find out why this happens and possibly prevent it from happening again. A visitor commented that they have seen poor manual handling technique and that the hoist is seldom used in the evening. It is unclear how the home is meeting the needs of one resident who is described as ‘challenging’ and who has no speech. On the day of inspection it was reported that this person had struck out at a nurse. They were seen by the inspector becoming irritated with another resident and raising his hand to him. This man was poorly shaven, was wearing stained clothes and generally looked unkempt. Staff report that he does not always like them near him and they do not know why. The home had contacted the local Community Psychiatric Nurse (CPN) for advice. This advice given had been put into practice but seemed to be having little effect. Discussions with the manager and owners demonstrated that some changes had been made to improve the quality of this resident’s life. The inspector discussed with the management team the possibility of contacting the Speech and Language Therapist for advice and/or training. The care plan of another resident showed that she has one pressure sore on one hip. The care plan states that she must be turned two hourly. The records do not show that this is happening and this person is developing a reddened area on the other hip. On the whole, medication is well managed. The home has recently started using a monitored dosage system that they say is working well. There is a dedicated fridge for those medicines that require refrigeration and storage of medicines is good. Some records were checked and appeared in order. However, the medication records of one person with diabetes raised significant concerns in relation to records and administration. The home has been required to deal with this immediately. The direction on another medication record was unreadable and there was some confusion as to the circumstances that should lead to the omission of another medication. Again, the home has been required to deal with this immediately. The inspector spoke with staff about how they ensure that they protect the privacy and dignity of residents. They demonstrated a good understanding of the importance of this and gave good examples of how they achieve this. However, during the inspection not all staff knocked on doors before entering Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 13 bedrooms and one resident was given a medicine into her exposed abdomen in a full dining room. Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 14 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, 13, 14 and 15. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Little progress has been made in relation to meeting the social and lifestyle needs and expectations of residents, although residents are helped to maintain contact with family and friends and can exercise some choice and control in their daily lives. Residents are offered a diet which is varied, well presented, nutritious and thoroughly enjoyed. Some residents are not always given the assistance they need to get full benefit and enjoyment from this and are not always able to receive this at times that necessarily suit them or in a relaxed environment. EVIDENCE: The home has recently employed an activities co-ordinator who will work from 9am–1pm Monday to Friday. She plans to ask residents what they would like to do socially and will try to arrange this. She is yet to receive training and, understandably, has had little effect yet. None of the surveys returned by residents to the Commission were happy with the activities on offer. Some care plans contained really detailed life stories and information about interests but it is unclear how this is used to enhance Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 15 the lives of residents. One resident said she would love to do something with her hands and that she does nothing all day. Staff interactions with residents on the day of inspection involved care giving only. For a period of one hour the majority of residents were in the lounge. They spent the majority of this time alone, unoccupied and unsupervised. Short interactions (1-2 minutes) took place but were mainly based on giving care and not on meeting social needs. One lady took her top off but staff did not find out why or what this lady wanted. When she refused to put her top back on, she was taken to her bedroom. One visitor to the home said that residents are often left unattended and unsupervised for long periods of time. Visitors say they can come any time, are warmly welcomed and offered a cup of tea and a chat. The majority of residents really like the food at Honiton Manor. Descriptions include ‘beautifully presented’, ‘lunch is magic’, ‘breakfast is smashing’ and ‘five star’. It is prepared on the premises and the cook reports she uses as many fresh ingredients as possible. The inspector saw a selection of fresh vegetables, fruit left out for residents in the dining room, grapefruit for breakfast and a variety of melons as a sweet alternative to a beautiful looking trifle and cheesecake. Residents are encouraged to meet in the dining room for lunch. However, this is a small room that struggles to accommodate all those residents who require wheelchairs all at the same time. On two separate occasions residents complained of discomfort. One had his legs pushed against the table leg and another bumped into the legs of the resident opposite her. Residents were seated at the tables for a long time before lunch was served (up to 30 minutes) and one gentleman became mildly agitated because of the wait. Another resident’s movements annoyed the man sitting next to him who acted as if to strike out. The food served looked appealing and was hot. However, the atmosphere was noisy, busy and business like. The sociability of mealtimes needs to be improved. Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 16 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): 16 and 18. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Practice in relation to acting upon complaints could be improved. The safety of residents is protected to some extent but could be improved by further training. EVIDENCE: Seven of the surveys returned by residents/relatives said that they always knew who to speak to if they were not happy. Verbal comments indicated that some staff are more approachable than others and one relative felt that the owners should be more visible, which had worked well in the past. Each care plan contains a complaints form. However, these are not visible to residents or relatives and are seldom used. One relative had had cause to complain and the system in place at the home had not been used. The Commission has received no complaints about this service since the last inspection in November 2005. Staff demonstrated a good understanding of abuse and what to do if they suspected or observed it. A training programme about abuse and protection from abuse has commenced, and is ongoing. Residents and relatives said that they feel safe and well cared for. Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 17 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, 22 and 26 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Improvements to the décor have made the home a more comfortable and pleasant place to live but the environment does not meet the needs of all residents. The home is clean throughout. EVIDENCE: Honiton Manor is an older building that has been adapted for use as a care home. There are two floors that are linked by a passenger lift. Steps inside the home have been covered by ramps to improve access but this does not completely overcome the problem. Two areas are of particular concern. In one area two steps have been covered with a moveable ramp. The inspector observed two carers moving a resident through this area into her bedroom. They had to first line the ramp up with the wheels of the wheelchair, then one carer pushed and another pulled the resident and the chair up the ramp. In another area there is a ramp which is steep and over which, staff report, the medicines trolley, wheelchairs and hoists have to be pushed. These issues pose Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 18 a potential risk to any member of staff who undertakes these manoeuvres and might limit the number of times residents are taken to and from their bedrooms. Risk assessments have not been carried out. The bedroom of one resident has a door which is a fire escape and which is therefore able to be opened from the inside. The occupant of this room has cognitive problems. A risk assessment/action plan has not been carried out in relation to this room and the current occupant. Call bells are not available to all residents in the lounge, some of whom have to call out for assistance or have to rely on other residents to call for assistance on their behalf. The owners have made many changes to the interior of the home to improve the layout, which has included creating a dining room and have decorated many areas. They have plans to make more changes including the installation of a second sluice (work is currently under way) and the complete refurbishment of the kitchen. The outside of the home is being repainted and some windows are due for replacement. Whilst this work is being undertaken there is no dedicated outside area for residents to sit in. One of the owners reports that the development plan for the home includes plans to have a garden/courtyard area that is secure. The cleaners are well appreciated by the residents who say they keep the home ‘spotless’, are ‘good’ and always clean bedrooms well. One resident says they also carry out little shopping tasks if asked. Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 19 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): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Practice in relation to staff training, recruitment and the deployment of staff are combining to put residents at risk. EVIDENCE: Residents describe staff as ‘always kind’, ‘excellent’ and ‘good and kind’. They also say they are busy and there was evidence of this throughout the inspection. Apart from their care duties staff undertake laundry duties and help to prepare suppers (although the majority of the preparation is done by the cook before she leaves). They do not appear to have time to spend with residents meeting their social needs (see Daily Life and Social Activities) and records show little interaction apart from the provision of care. The new owners have commenced a training programme for staff which, when completed, should help them to better meet the needs of residents. This is now co-ordinated by the deputy manager who has also recently developed an induction programme. Training organised or given includes ‘Skills for Care’, National Vocational Qualification in Care, the Protection of Vulnerable Adults and Manual Handling. Registered Nurses report they keep up to date with training and current practice. The deputy manager recognises that there are gaps in training and is working towards achieving this. 12 of staff are trained to NVQ level 2 or above, and although other staff have commenced this Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 20 training, this figure is well below the recommended standard of 50 of staff being trained to this level. Throughout the inspection, and comments from residents and relatives, indicate that the majority of staff are able, well motivated and keen to provide a good service. It is unclear whether current staffing levels after 4pm are adequate to meet the needs of all residents. One resident commented that it can take a long time for the call bell to be answered in the afternoon (after 4pm there are two carers and one nurse on duty). The manager reports (in the Preinspection Questionnaire) that the majority of residents need help with toileting, dressing and undressing; that at least half need help with eating meals and a significant number need the help of two staff. In addition it is possible that on occasion two staff are needed to access certain areas of the home (see Environment). Staff report that all but one resident goes to bed before the night staff come on duty, as is their choice. Although there is a kitchen assistant on duty to serve suppers, they do not assist residents to eat, meaning that some residents do not get the assistance they need. Recruitment procedures are not robust enough to protect residents. For example, information on application forms is incomplete and not appropriately followed up. References are not always obtained from the most recent employer (as is good practice) and one member of staff has not yet received a full Criminal Record Bureau (CRB) check but is working unsupervised potentially placing residents at risk. Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 21 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, 35 and 38. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Since the arrival of the new owners, there have been some positive improvements which staff welcome and which it is anticipated will have a positive impact on residents. Service users could be better protected with continued improvements in managements systems and the training provided. There is currently limited opportunity for residents to be involved in looking at the quality of services provided at the home. EVIDENCE: Although the manager at Honiton Manor has not undertaken the Registered Managers Award (RMA), she has undertaken other care and management training that she feels equips her to carry out her role. The deputy manager Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 22 has commenced the RMA and has also been delegated responsibilities in relation to training and pre-admission assessment. The owners report they have done little in the way of assessing the quality of services offered as they are in the middle of changing many aspects of the management systems in the home and the way in which services are offered. Residents report that there have been many changes, some of which are yet to have a positive impact. Residents’ monies are handled through a billing system, with receipts and records kept for audit purposes. The health, safety and welfare of residents is not fully promoted or protected as detailed in Staffing and Health and Personal Care, and not all staff have received the necessary mandatory training such as manual handling and fire training. Risks posed to residents have not always been assessed and actions to be taken to minimise these risks have not been undertaken. Where assessments are in place, they mostly need updating. The pre-inspection questionnaire provided by the manager stated that all mandatory checks and controls are in place. These include fire drills, the maintenance of fire and lifting equipment and gas checks. Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 23 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 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X X 2 X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 1 Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 24 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 OP1 Regulation 4 (1) (2) Requirement 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. Previous timescale of 31/01/06 not met. You must compile in relation to 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. Previous timescale of 31/01/06 not met. You must prepare a written plan for each resident as to how their needs in respect of health and welfare are to be met. This plan should be kept under review. Timescale for action 31/08/06 2. OP1 5 (1) (2) (3) 31/08/06 3 OP7 15 (1) 31/08/06 Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 25 4. OP8 12(1)(a) You must ensure the home is 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) and care planned for residents with diabetes. Previous timescale of 31/01/06 not met. 31/07/06 5. OP9 13 (2) 6. OP10 12 (4) 7. OP12 16 (2) (m) (n) 8. OP15 16 (c) (i) 9. OP18 13 (6) You must ensure that arrangements are made for the recording and safe administration of medication. (This refers to the need to ensure that instructions regarding medications are clear and followed). You must ensure that the care home is conducted in a manner that respects the privacy and dignity of residents. You must consult residents about their social interests and a programme of activities and make arrangements to enable them to engage in local, social and community activities. You must ensure that all residents receive adequate amounts of food and drink. (This relates to ensuring that vulnerable residents are given the assistance they need and monitoring of food and fluid intake takes place). You must make arrangements to prevent residents being harmed or being placed at risk of harm or abuse. (This relates to continuing with the programme of training and ensuring that all incidents are thoroughly investigated). DS0000065696.V293229.R01.S.doc 30/06/06 31/07/06 30/10/06 31/07/06 31/03/07 Honiton Manor Version 5.2 Page 26 10. OP19 23 (2) (a) (o) 11. OP19 13 (4) 12. OP27 18 (1) 13. OP29 19 (1) 14. 15. 16. 17. 18. OP38 OP38 OP38 OP38 OP38 16 (2) 13 (4) 13 (5) 23 (4) 13 (3) You must ensure that the layout of the home meets the needs of residents and that external grounds are provided for use by residents. You must ensure that all parts of the home are free from hazards (so far as is practical) and that unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. (This relates to ensuring risk assessments and action plans are in place. You must ensure that at all times there are enough people working at the care home to meet the needs of residents. (This is in relation to meeting residents’ needs after 4pm). You must ensure that you do not employ a person to work at the care home unless you have carried out all the necessary checks specified in Schedule 2. You must ensure that all staff who handle food receive food hygiene training. You must ensure that sufficient numbers of staff (one per shift) are trained in first aid. You must ensure that all staff receive manual handling training. You must ensure that all staff receive fire training and are involved in fire drills. You must ensure that all staff receive training in infection control. 31/03/07 31/10/06 31/08/06 31/08/06 31/03/07 31/03/07 31/03/07 31/12/06 31/03/07 Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 27 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. 3. 4. 5. 6. 7. 8. 9. Refer to Standard OP3 OP7 OP8 OP8 OP15 OP16 OP19 OP22 OP28 Good Practice Recommendations You should ensure that each person entering the home do so on the basis of a full assessment undertaken by a person trained to do so. You should ensure each resident’s care plan includes their social care needs. You should carry out appropriate interventions for residents identified as being at risk of falling. You should ensure that residents who are at risk of developing pressure sores and that appropriate interventions take place and are recorded in the care plan. You should ensure that mealtimes are unhurried, are taken in comfort, in a congenial setting and are at flexible times. You must ensure that there is an accessible complaints procedure in place and that complaints are dealt with promptly and effectively. You should continue to implement the programme of renewal as agreed during the registration process. You should ensure that call systems are accessible to all residents. You should ensure a minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved, excluding the registered manager & registered nurses. You should develop effective quality assurance & quality monitoring systems, based on seeking the views of residents & other stakeholders. 10. OP33 Honiton Manor DS0000065696.V293229.R01.S.doc Version 5.2 Page 28 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 © 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.V293229.R01.S.doc Version 5.2 Page 29 - 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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