Inspection on 07/11/07 for Honiton Manor

This inspection was carried out on 7th November 2007.

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

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 Exeter Rd Honiton Devon EX14 1AL Lead Inspector Teresa Anderson Unannounced Inspection 7th November 2007 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 DS0000065696.V342856.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. DS0000065696.V342856.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Honiton Manor Address Exeter Rd Honiton Devon EX14 1AL 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) 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 Ms Gillian Sarah Mary Berry Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places DS0000065696.V342856.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th March 2007 Brief Description of the Service: Honiton Manor is registered to provide 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. One of the bedrooms has an ensuite bathroom. A passenger lift and a 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 limited access to a garden and 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 £372.00 to £737.00 per week. Charges do not include items such as newspapers, toiletries, taxis etc. DS0000065696.V342856.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 an inspector from the commission who was accompanied for part of the visit by an ‘Expert by Experience’. This person has had personal experience of care services. She spoke with some of the people living at Honiton Manor about their experience. In the main, she spoke with them about their daily activities and lifestyle and about how they are supported to make choices. Her comments are included in the report. We arrived at 09.30am and the ‘expert by experience’ left at about 12.00am. The inspector from the commission left the home at 6pm. During that time she ‘casetracked’ the care and services offered to three people as a way of judging the standard of care and services generally. Where possible she spoke with these people in depth. She looked at their care assessments and care plans closely, and spoke with staff about their knowledge and understanding of the plans. Both people looked at some bedrooms and we looked at the overall environment from the perspective of people who live here. The inspector also spoke with the manager and the deputy manager, with nurses, carers and kitchen staff. She looked around the building at all communal and service areas and saw many of the bedrooms. She looked at other records including medication, staffing, accident and incident reports, training, fire safety and recruitment. Prior to this visit to the home surveys were sent to various people asking for feedback and comments. 10 surveys were sent to people who live here and 8 were returned; 7 to relatives of the people who live here and 7 were returned; 10 to staff and 5 were returned; 17 to health and social care professionals who attend people living here and 7 were returned. Their feedback and comments are included in the report. Other information given to the commission throughout the year has been taken into account. In addition, and before we visited, the manager provided information about the management of the home and her own assessment of what the home does well and what they plan to improve upon. After the last inspection we met with the owners and Registered manager of Honiton Manor to discuss the improvements needed with regards to the requirements made at that inspection. They provided a comprehensive improvement plan and have achieved many of their aims. DS0000065696.V342856.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? DS0000065696.V342856.R01.S.doc Version 5.2 Page 7 Since the last inspection the manager and staff have worked hard to bring about improvements. They have improved how assessments of prospective residents are carried out and have improved the planning of people’s care in relation to their physical needs. Medicines are being kept securely and safely and the overall management of this is much improved. Knowledge in relation to safeguarding people has also improved. Issues raised last time in relation to the environment and infection control have been dealt with and recording in relation to fire training has improved. The refurbishment and redecoration programme continues. Checks carried out on staff before they come to work here are now robust. Information is being stored securely. What they could do better: People who come to live here with help from Social Services do not have the terms and conditions of occupancy explained to them in writing. This means that some people’s rights are reduced. Although comprehensive information about the home is available, some people cannot use all the facilities because of the number of people who live here who have dementia and behaviours which can be disruptive. Staff continue to work towards giving and planning care that is person centred and individual to each person, but have not yet achieved this. Reviews take place but judgements about the effectiveness of interventions for those people with dementia cannot always be made because these care plans lack detail. People do not always have their privacy and dignity fully protected. For example some staff use terms such as ‘good girl’ and use one person’s private space to store wheelchairs. People’s social needs are not well met. The activities co-ordinator has been on sick leave and this role has not been designated to anyone else. There is not a programme of activities and staff say they do not always have time to chat or to give one to one attention. Sometimes staff have to use measures to keep people safe. They are not using the Mental Capacity Act code of practice to guide their actions or recordings. The home has one lounge and not everyone likes to use this because some people who sit here can be disruptive. Bedrooms are not all tidy or personalised and one bathroom is not homely. Staff are not aware that people should make a positive choice to share a bedroom, so some people may be sharing when they choose not to. Some fire doors do not close properly meaning that people are at risk if a fire breaks out. In addition, a freestanding electric heater is being used to heat the DS0000065696.V342856.R01.S.doc Version 5.2 Page 8 dining room. This is hot to the touch and is posing a risk to people. (The manager reports these issues have since been dealt with). It is recommended that 50 of care staff hold a National Vocational Qualification in care. 28 of the care staff working here have this qualification and one person is working towards achieving this. Staff have additional training related to the needs of the people who live here, but do this in their own time. Risk assessments are not always carried out or where they are do not identify the potential risks. Appropriate actions are not taken to ensure that people are kept safe. The requirements made by the Environmental Health Officer should be complied with. The Responsible Individual was required at the last inspection to carry out monthly unannounced visits to the home. The findings were to be used to help them to form an opinion as to the standard of care provided at the home. They were to send their findings to the commission. This was agreed as part of an overall improvement plan. This has not been done. 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. DS0000065696.V342856.R01.S.doc Version 5.2 Page 9 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 DS0000065696.V342856.R01.S.doc Version 5.2 Page 10 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 and 3. Standard 6 was not inspected as this home does not provide intermediate care. Quality in this outcome area is adequate. Some people living here do not have contracts written in sufficient detail to protect their rights. Comprehensive information is available about the service but this does not always help people to make an informed choice about where they live. People can be assured that their needs will be assessed prior to coming to live here. This judgement has been made using available evidence including a visit to this service. DS0000065696.V342856.R01.S.doc Version 5.2 Page 11 EVIDENCE: Honiton Manor has a comprehensive guide giving details about the home and the services offered. It is registered to provide personal and nursing care to people with needs relating to old age. However, a number of people living here have dementia type illnesses, some of whom have behaviours that are challenging the service. People say that they were not aware of this when they chose this home. Information given to us by the home told us that nine people living at the home have dementia type illnesses and that two have other mental health needs. Staff said that there are normally three people living at the home who have behaviours which challenge the service, although one is currently in hospital undergoing a reassessment at the request of the home. In surveys people say they have a contract and we checked three. Private contracts are comprehensive. However, the home does not provide terms and conditions of occupancy for those people who contract through Social Services. For example they do not give the details of any notice period which may be given and under what conditions notice may be given and do not record the bedroom that is being contracted for. The deputy manager reports that since the last inspection one person has been admitted. We looked at the assessment undertaken by staff and found that this has improved. The information collected is more comprehensive and provided more details on which staff can make a decision about whether or not this service can meet their needs. DS0000065696.V342856.R01.S.doc Version 5.2 Page 12 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 adequate. People who live here have their physical healthcare and medication needs met through good planning and management. People who have mental health needs are not always having their needs planned or met, and care planning for them is not always person centred. The degree to which peoples privacy and dignity is respected could be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person living at Honiton Manor has a plan of care and we looked at three as part of assessing the quality of care overall. We found that all contained details of all aspects of the activities of daily living. Core needs such as maintaining nutrition and hydration, moving and handling and skin care needs are identified. Plans are put in place which detail how these needs will be met DS0000065696.V342856.R01.S.doc Version 5.2 Page 13 and these are reviewed as needed to ensure the plan is working. Details about the favourite foods of people are kept to help encourage people with poorer appetites to eat. Care plans show that people are maintaining their weight even when the risk of malnutrition is high. The manager reports that no one living at the home has a pressure sore. In surveys people who live here say they always or usually get the care and support they need. One person said ‘I would be in an awful state without the help they give me’. Healthcare professionals say they are satisfied with the care provided. One professional commented that this service always seeks advice and puts it into action. Since the last inspection there have been improvements in the way health care needs are met. However, people with dementia are not always having their needs recognised, appropriate actions are not always taken and care planning is not always person centred. For example we found that one person calls out and the care plan shows that staff take this person to their room and that this is their preference. However, the care plan instructs staff to encourage this person to remain in the lounge. Some staff say they take this person to their bedroom to protect other people from the disturbance their calling out causes. The care plan gives staff some guidance about other things to try to prevent this calling out but there is no evidence that these interventions are taking place. In addition, this person continues to call out at night when they are in their bedroom and some people say their sleep is disturbed. When we spoke with staff about this person’s behaviour, they described (and we observed) this to be an habitual behaviour which does not change with intervention. Even when there is someone sat with and talking to this person, they continue to call out. However, the care plan does not give staff instructions on how to deal with this in a way that meets this person’s need to call out and be answered and other people’s need for peace. Staff say they deal with it the best they can, but that different people deal with it differently. One visitor commented in a survey ‘giving out cotton wool to put in ears is hardly a satisfactory solution’ to people calling out. The manager reports that this does not relate to the person we case tracked, indicating that more than one person calls out and causes a disturbance for other people. The care plan of another person gives staff instructions about when a seat belt being used to prevent this person from falling can and should be removed. Staff spoken with were aware of some of these instructions but not all. This might mean that this person is restrained for long periods of time. We also observed one member of staff undoing the seat belt and then leaving the room, leaving this person unsupervised. Staff report this person does not like wearing the belt and often wriggles out of it and continues to try and walk. As DS0000065696.V342856.R01.S.doc Version 5.2 Page 14 this person clearly still wants to be helped to walk, this activity should form part of their care plan. When we looked, it does not. However, some staff say they do try to walk her. This person also likes to take their clothes off. Staff say that they like to ‘fiddle’ and when given something will stop undressing. However, although the care plan directs staff to give this person something to fiddle with other than their clothing, the daily records indicate that the favoured intervention is to take this person to their room, and not to give them an activity to engage with. Care plans are reviewed regularly. A judgement is made about how well interventions to aid physical health are working. However, because care plans do not give specific instructions about how to meet mental health needs and because staff are not always recording how they have met these needs or the outcome of interventions, judgements about whether the care being delivered is appropriate cannot be meaningfully made. The manager reports in the information provided prior to the site visit that she has recognised person centred care planning as a training need and plans to continue to support staff to develop this. We looked at how the medications of the three people we case tracked are managed. We found that records are up to date and that all their medications are kept safely. All medications are reviewed and appropriate changes made annually, and more frequently when needed. We checked the medications of one newly admitted person and found that staff had not recorded all the medication they had bought in with them. This means that some medicines could not be accounted for. We checked the controlled medicines of one person and found them to be in order. Recordings relating to the temperature of the fridge where medicines are stored showed that this is kept at a suitable temperature. At the last inspection we were concerned that the room where medicines are kept could become to hot. Since then a record is kept of the temperature of this room, an aluminium blind has been put up at the window which staff reports reflects the heat of the sun and a fan is kept in the room just in case it still becomes too warm. During the inspection we heard many of the staff using terms such as ‘good girl’ and ‘darling’. We saw some staff ignoring people who were trying to talk with them. We also saw some staff talking over people who were talking to them. In one survey we were told that in the past one persons ensuite bathroom was being used to store wheelchairs but that this had stopped. When we checked we found that it was again being used for storage with staff walking through this room frequently to get wheelchairs, which impinges on this persons privacy. When we asked staff, they confirmed this is happening because there is nowhere else to store these. DS0000065696.V342856.R01.S.doc Version 5.2 Page 15 DS0000065696.V342856.R01.S.doc Version 5.2 Page 16 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. Links with the community and visitors are good, although opportunities to support and enrich some residents’ social lives could be improved. Support is offered in a way that helps to promote choice and flexibility. The meals provide choice, variety and meet peoples’ nutritional needs. EVIDENCE: In surveys people say there are usually or sometimes activities available that they can take part in. When we checked we found that the activities coordinator has been on sick leave and this role has not been designated to anyone else. Some people told us that they had been on trips out to a local nursery and the donkey sanctuary. Some people said that there used to be a bingo session but this has stopped. A lay preacher visits the home once a month to hold a service and offer communion. Staff say they like to engage with people on a one to one basis but do not always have time to do this. At the last inspection we said that the way that people’s interests are assessed is not person centred. People choose what interests they have, or had prior coming to live here, from a list of options offered by the home. There is no DS0000065696.V342856.R01.S.doc Version 5.2 Page 17 evidence that these assessments form the basis for a plan of care that helps people to remain socially interested and not become bored. Care plans entries show that some people love to chat. Staff confirm this and say they try to do this when carrying out tasks. However, this does not form part of the plan of care and staff say this is not something they have time to do. One person said that they would like to walk more but that this was not happening. Visitors to the home say they are always made very welcome, offered refreshments and some choose to have their meals with the person they are visiting. In surveys relatives say they are kept up to date with important issues. People say they make choices such as what to eat and the clothes they wear. Care plans include a record of each persons daily routine preferences and staff say that people get up and go to bed when they want to. People and relatives we spoke with confirmed this. In surveys people say they usually like the meals at the home. One visitor commented ‘lunch yesterday was excellent’ and another person says the food is always good. People say there is lots of choice. For example they have a choice of cereals or toast with juice and hot drinks for breakfast, and there are always two choices of meals at lunchtime. Fresh fruit is available. However, one person said that people are not allowed to help themselves but must ask. Another person said that although they are not allowed to help themselves, a carer usually makes sure they have their favourite fruit everyday. We did notice that when hot drinks were being served some people had their biscuits chosen by staff who handed them to them. One person who did not like the biscuits on offer and took one from their own supply. DS0000065696.V342856.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 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 good. People’s views and complaints are generally listened to and acted upon. People feel safe and well cared for. Staff knowledge in relation to adult protection is good, however good practice in relation to the Mental Capacity Act is not always being followed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys people say that staff listen and act on what they say. Half of the people who live here who responded in surveys say that they know how to make a complaint and the other half don’t. All relatives or friends who completed surveys say they know how to make a complaint and that staff always or usually respond appropriately. The homes own quality assurance survey highlighted that some people do not know how to make a complaint. However, this information is in the guide to the home which is in every room and the manager says she reinforces this information. When we spoke with people, those who were able to discuss this DS0000065696.V342856.R01.S.doc Version 5.2 Page 19 with us say they speak with a nurse, carer or the manager. One person said they had made a complaint to the manager and this had been dealt with. The home or commission have received four formal complaints about this service. All were investigated by the home, were dealt with within the stated time period of 28 days and none were upheld. Staff have received training in safeguarding vulnerable people and demonstrate a good understanding of what abuse is and what to do if they saw or suspected abuse. People say they feel safe and that staff are kind. One person living at Honiton Manor is being restrained in their chair. There is some documentation relating to this that includes agreement from a doctor and a relative. Senior staff have received training in the Mental Capacity Act and the issues of restraint, consent and capacity. However, they are not applying the principles or using the Code of Practice to guide their actions. In addition staff are not following the instructions in the care plan as to when the restraint should not be used. DS0000065696.V342856.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23 and 26. Quality in this outcome area is adequate. Refurbishment of this home continues and is helping to enhance the overall decor. Although it is clean, some areas are not homely and a lack of attention to fire regulations is placing people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys the majority of people who live here say the home is always clean and fresh, others say it usually is. During this site visit we found the home clean and odour free. Infection control procedures such as hand washing facilities are in place and we saw staff using them. Some bedrooms and the lounge have been redecorated. Carpets have been replaced in the hall, lounge, stairs and some bedrooms. People are really pleased with the ongoing refurbishment and hope this will continue. DS0000065696.V342856.R01.S.doc Version 5.2 Page 21 Since the last inspection the owners report they have consulted with an Occupational Therapist regarding the ramped areas in the home which might cause some problems with access. They have extended the ramps to provide a less steep gradient and report they are considering buying a powered wheelchair. The home has one lounge. This is bright and airy. However, some people prefer to stay in their rooms because the people who call out disturb them or because other people are not well enough to have a conversation. Three people said they don’t go in the lounge because of the ‘shouting and hitting’. One visitor (whose relative does sit in the lounge) said they would like to sit with their relative in private but there is no where (except the bedroom) to do this. The manager reports that the home does have a dining room which people can ask to use. We did find that some bedrooms are not tidy or personalised because pads, gloves and aprons are left on surfaces. One bathroom isn’t very homely. It contains unnecessary equipment, the bath has black marks and the grout is cracked, the blinds at the windows don’t work and there is a commode with coloured liquid in it. When we checked we were told that this is a bathroom that people frequently use. However, the manager reports that this bathroom is planned for refurbishment and the installation of a bath which will be easier for people with disabilities to use. Some of the rooms at Honiton Manor are shared by two people. However, some people are not making a positive choice to share as they should do. When we checked we found that the person who carries out assessments and agrees admissions was not aware of this. This means that some people might have to share a room when really they do not want to. As we walked around the home we found a number of fire doors that did not close properly. Although we did not carry out a complete audit we counted at least 5 fire doors that did not close when we walked through them. We found that radiators have been covered to prevent accidental scalding. However, we also found a freestanding electric heater in the dining room. This is hot to the touch and is placed close to where people sit in this room. This was an issue that we asked the manager to address at the last inspection. We bought these issues to the attention of the manager during the site visit. DS0000065696.V342856.R01.S.doc Version 5.2 Page 22 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 good. People who live here are supported by kind and caring staff who are employed in adequate numbers and who receive training. Recruitment processes have improved, are robust and help to protect people from unsuitable workers. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In surveys people say that staff are very ‘caring and helpful’, ‘loving’ and ‘caring and efficient’. They also say they are kept busy and sometimes it can be difficult to find them. Staff and some of the people who live here say that the dependency levels of the people who live here have increased over the past two years. They also say there are more people with dementia type illnesses who need a lot of attention. The rota shows that there is always a nurse on duty. In the morning there are usually also four carers on duty; in the afternoon there are usually three carers and a kitchen assistant on duty and at night one carer (working with the nurse). In addition there is a cook every day and on some days there are one or two cleaners and a catering assistant. DS0000065696.V342856.R01.S.doc Version 5.2 Page 23 In the information provided by the home it shows that 28 of staff hold a National Vocational Qualification in care to level 2 or above. One person is currently studying for this. This is below the 50 that is recommended. However, some staff working at the home have trained as nurses abroad and are planning to undertake further ‘conversion training’ to become Registered Nurses in the UK. Records show that staff receive other training which includes caring for people with dementia, caring for people who challenge the service, wound management, visual disturbances and caring for people with Parkinson’s disease. However, some staff say they do not always feel able to care for people with dementia. The manager, in the information provided prior to the site visit, reports that staff receive mandatory training during work time and do other training in their own time, although they are entitled to receive three days paid training each year. We checked the recruitment files of the three most recently recruited members of staff. We found that the manager had undertaken robust recruitment checks to help ensure that all the people who work here are suitable to work with vulnerable people. Checks include two written references, proof of identity and a police check. DS0000065696.V342856.R01.S.doc Version 5.2 Page 24 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 good. People benefit from living in a home where the management continues to improve. Progress is being made in relation to ensuring the home is run in people’s best interests and in improving person centred care. People’s health and safety is generally managed well at this home. However, additional risk assessments and action would further reduce the risk of harm or injury. This judgement has been made using available evidence including a visit to this service. DS0000065696.V342856.R01.S.doc Version 5.2 Page 25 EVIDENCE: Honiton Manor is managed by Gill Berry. She has worked at the home for many years and when the home was sold two years ago, stayed on as manager. Ms Berry is a Registered Nurse. She has not completed the Registered Manager’s Award, however her deputy has. Prior to this visit the manager completed a pre inspection questionnaire. In this she identifies the areas that have improved and where improvements are still needed. The information given shows that the home understands the importance of person centred care and plan to continue the work started to improve this. The manager and her team demonstrate a real desire to make improvements to the services offered. People working here say they enjoy the work and feel that the owners and manager are approachable and helpful. People living here say they like living here. The home carries out an independent quality assurance survey each year. Although the report does not include information on how changes have been made in line with issues raised, the manager assures us that these have all been addressed. People say that since the last inspection resident meetings have commenced and they like these. The minutes of the meeting show that people are enjoying the outings that take place. One person expressed their concerns about people being admitted with dementia and their ‘violence’ towards staff, and the possibility that they might hurt someone. Mandatory training continues and records are kept of all fire training, first aid, manual handling and food and hygiene training given. We looked in the kitchen and found it clean and tidy. A recent Environmental Health Officer visit noted there is no hand washing facilities or fly screening in the kitchen and have required this to be dealt with within two months. They also noted that the kitchen is coming to the end of its useful life. The cook says that the owners have plans to refit the kitchen. Thermostatic valves to prevent scalding control the temperature of bathing water. Staff say they also check the temperature of the bathing water before the person gets in as a double check. Records show that these temperatures are below scalding. People say that staff make sure that they get a ‘nice warm bath’. DS0000065696.V342856.R01.S.doc Version 5.2 Page 26 The manager reports that risk assessments relating to the home and the people who live here have been carried out. However, we found that the use of bed rails is not comprehensively risk assessed and the use of a free standing heater had not been risk assessed. After the last inspection, and as part of the overall improvement plan for home, the owners agreed to carry out monthly unannounced visits to home. They were to use these to help them form a judgement about overall standards of care in the home, and agreed to send their findings to commission on a monthly basis. They have not done this. the the the the We checked the accounts of 3 people living at the home. The home do not hold any cash, but run a debit account system. Records are good and receipts for purchases are given to relatives for checking. DS0000065696.V342856.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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 2 X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 DS0000065696.V342856.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 OP1 Regulation 4 (1) (b) Requirement Timescale for action 31/12/07 2. OP2 5 (b) 3. OP7 15 (1) In order to help people make an informed decision about where to live you must, in the statement of purpose, tell people that some of the people who live here have developed dementia and/or challenging behaviour. The terms and conditions of 31/12/07 occupancy must be included in the guide to the home so that people who have Social Services contracts understand them. People who have dementia must 31/03/08 have their care planned in a way that is person centred; identifying all their needs and detailing how these needs should be met. Care given must be reviewed in a way that helps the care planner to make a judgement about whether the planned care is meeting that persons needs. 4. OP9 13 People living here must be assured that their medicines are handled safely and securely. Staff must record all medicines DS0000065696.V342856.R01.S.doc 31/12/07 Version 5.2 Page 29 5. OP10 12 (4) (a) 6. OP12 16 (20 (m) (n) coming into the home so that all medicines can be accounted for. People living here must be treated with privacy and dignity. This includes not using their personal space for storage and using appropriate language and forms of address. 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 30/05/07 not met. 31/03/08 31/03/08 7. OP18 13 (8) When physical restraint is used the nature of the restraint, including the times when the person shall not be restrained, must be recorded and you should ensure that staff follow these instructions. Decisions about restraint must be made using the key principles of the Mental Capacity Act (2005). 31/12/07 8. OP19 23 (4) All the fire doors within the home 05/12/07 must close firmly in order to prevent the spread of fire. The use of the freestanding electric heater must be reviewed with Devon Fire and Rescue Service to ensure that this is safe to use. These issues were bought to the attention of the manager on the day of the site visit and a requirement was issued stating that this must be actioned immediately. Previous timescale of 05/04/07 not met. DS0000065696.V342856.R01.S.doc Version 5.2 Page 30 9. OP20 23 (2) (h) (i) 10. OP38 16 (2) (j) 11. OP38 13 (4) People living here must have access to suitable communal space which will meet the diverse needs of the people living here. People must be able to receive their visitors in areas that are private but are separate from their bedrooms. To ensure that the standards of hygiene do not negatively affect the people who live here, requirements made by the Environmental Health Officer in relation to fly screening and providing hand washing facilities in the kitchen should be complied with. For the safety of the people who live here, as far as possible risks should be identified and eliminated. On this occasion, this includes ensuring that the use of bed rails and the freestanding electric heater are risk assessed and appropriate actions taken. Previous timescale of 31.07/07 partially met. 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. Previous timescale of 13/04/07 not met. 31/01/08 31/01/08 31/12/07 12. OP38 26 31/12/07 DS0000065696.V342856.R01.S.doc Version 5.2 Page 31 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. Refer to Standard OP19 OP23 OP30 Good Practice Recommendations Incontinence pads and gloves should be stored more discreetly and attention should be paid to the bathroom that is not homely or welcoming. Where people share their bedroom with another person, this should be a positive choice. Staff should not have to undertake training in their own time. They are entitled to receive a minimum of three days paid training per year. DS0000065696.V342856.R01.S.doc Version 5.2 Page 32 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 DS0000065696.V342856.R01.S.doc Version 5.2 Page 33 - 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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