Inspection on 23/11/05 for Little Manor Nursing Home

This inspection was carried out on 23rd November 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Little Manor Nursing Home 03/12/07

Little Manor Nursing Home 24/07/06

Little Manor Nursing Home 09/06/05

Little Manor Nursing Home 13/01/05

Little Manor Nursing Home 12/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Little Manor Nursing Home Manor Farm Road Salisbury Wiltshire SP1 2RS Lead Inspector Karen Mandle Unannounced Inspection 23rd November 2005 9.30 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 Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Little Manor Nursing Home Address Manor Farm Road Salisbury Wiltshire SP1 2RS 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) 01722 333114 01722 336933 Wessex Care Ltd Mrs Jeanette Roselyn Cook Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26), Terminally ill over 65 years of age (2) of places Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users who may be accommodated at any one time is 26 No more than 2 service users aged 65 years and over with a terminal illness may be accommodated at any one time Only the one, named service user currently in residence in the Home may be under 65 years of age The staffing levels set out in the Notice of Decision dated 20 July 2004 must be met at all times 9th June 2005 Date of last inspection Brief Description of the Service: Little Manor is registered to provide nursing care for 26 older people who are 65 years or older. Due to the nursing registration a qualified nurse is on duty at all times supported by a team of carers. The home is an older property, which has been extended several times. The bedrooms are individual and provide a homely environment. The bedrooms are single apart from two. A communal room is provided which over looks the well maintained garden. The home is owned by Wessex Care Limited. The owners of the company remain very much involved with the day to day management of the home. The Registered Manager is Mrs Jeanette Cook RGN. Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced at 9.20am and was completed at 3.30pm. Karen Mandle was assisted with the inspection by Sally Walker Regulation Inspector. The inspectors visited with many service users during the tour of the building. Reviewed care records and medications. The current Registered Manager was unavailable during the course of the inspection. The Registered Providers Mr and Mrs Airey are managing the home in the interim and are working hard to deal with a number of management issues requiring attention. Additional Visits: An additional visit to the home was conducted 13th July 2005, in response to a complaint the CSCI received. The inspector concluded that of the eleven issues raised in the complaint, five were upheld, two were not upheld, two upheld in part and two were unresolved. What the service does well: What has improved since the last inspection? Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 6 The medication procedure has improved with the medication now stored securely and all medication signed into the home. Medical equipment was clean and stored correctly. 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. Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 5 were assessed and met at the previous inspection. EVIDENCE: Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 9 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 The standard of care records was variable with some care records not fully addressing all care needs. Health care needs are monitored, however service users being fully supported with fluids was questionable. The medication procedure was safe apart from the amount of stock kept in the home and prescribed creams not being stored correctly. The privacy and dignity of the service users is supported by the care team. EVIDENCE: Each service user is provided with a care plan. The inspectors reviewed 5 care plans following visits with the service users. The information in the care plans varied depending on the nurse who had compiled the care plan. Two care plans were detailed and provided a full picture of the service users care needs, whilst three did not. Two service users who suffered from epilepsy had no care plan in place to support the long-term condition. A pressure area risk assessment was incorrect and did not relate to the service users high tissue viability needs. However the inspector visited the service user again and found that the correct tissue viability equipment was in place. Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 10 All service users are registered with a local GP with clear written evidence of the GP visits. Health care needs are monitored. However the inspectors did find that either service users were not being fully supported with fluid intake or, that the fluid charts were not being completed. However dietary needs were being met with evidence that many service users had gained weight either in the last few months or since admission to Little Manor. A care chart had not been kept up to date and indicated that a service user had not been repositioned since 1am. The inspectors reviewed the care chart at 9.50am. The inspectors spoke with a new service user and their relative both of whom were very satisfied with the care and support provided. Many of the beds including two empty beds had a protective sheet (kylie) which should only be used as part of a continence management programme on an individual basis as these sheets are not very comfortable for service users and the assumption could be made that the service user is incontinent. The inspectors did observe a good standard of personal care being provided. Service users who were able to communicate confirmed that all nursing and personal care was performed in the privacy of their bedroom or bathroom. The medication procedure was reviewed and all medication was stored safely as was the medication trolley. However the stock of medication kept in the home was not correctly managed. The medication administration sheets did not give the time that the medications were being given. The homely remedy policy did not include a medication found in the stock medication cupboard clearly labelled as homely stock. The inspectors found prescription creams left in bedrooms and dressing stored in appropriately round the home. Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 11 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): 13, 14 and 15 Service users are supported by the home to retain links with family and friends. Service users are provided with support to make choices and have control of their own lives where possible. Service users’ enjoyed the food and a varied well balanced diet is provided by the home. EVIDENCE: Service users are supported by the home to retain contact with family and friends who can visit at anytime. The visitors signing in book provided evidence of this taking place. Service users who were able to communicate confirmed that they were supported with choice as to when they went to bed or how they wished to spend their day or what activities they wished to do. As previously stated in the report the dietary needs of service users are met with many service user showing evidence of weight increase. Service users were complimentary of the standard of food provided. A dining area is provided in the communal room or service users can have their meal in the privacy of their bedroom. Service users requiring assistance with their meals were observed being provided with help from the care team on a one to one basis. Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 12 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): A complaints policy and procedure is in place. The staff had been informed of the local vulnerable adults procedure. EVIDENCE: A complaints policy and procedure is in place, which is available in the entrance hall to the home for service users and visitors to read. The CSCI have recently received 1 complaint, which was investigated by the CSCI. Two service users reported that if they had a complaint or concern that they would talk to a nurse. A procedure is in place for dealing with any allegations of abuse. The home has a copy of the “No Secrets” document, which was seen available to all staff. A “Whistle Blowing” policy is in place. Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 13 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, 24 and 26 Little Manor provides a homely and comfortable environment for service users to live in. The home was clean apart from two bedrooms. Infection control practices were satisfactory. EVIDENCE: Little Manor is an older building, which has been extended providing a homely and domestic environment for service users to live in. The current providers have put much investment into improving all environmental standards throughout the home. It was identified that and en-suite facility did need to be refurbished as the sink appeared to be leaking and the names of the service users sharing the en-suite had been written on the walls which does not present as a homely environment for service users. Many bedrooms were visited which were very personalised and homely. All bedrooms were well furnished. Two bedrooms did smell of urine and an unoccupied room had not been sufficiently cleaned ready for a new service Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 14 user. However generally the home was clean but it will be recommended that a weekend cleaner should be employed to ensure the home is supported with domestic staff at the weekends. Cross infection issues are addressed and clinical waste appropriately managed. Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 15 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 The number of staff available was sufficient to meet the nursing and personal care needs of the service user group. EVIDENCE: The staffing rotas provided evidence that a trained nurse was on duty at all times ensuring that the nursing care needs of the service users are met. At the time of the inspection 5 carers were available to support the service users with personal care. The carers were busy during the morning period but appeared calm and well organised. The home was providing care for 23 service users. Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 16 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): 38 Health and safety issues are addressed but some manual handling practices placed both service users and staff at risk. EVIDENCE: The home is well maintained through out. All accidents are recorded and regularly audited. Electrical equipment is tested annually and servicing of the four lifting hoists takes place regularly. The fire log indicated that weekly testing of the fire alarm system was taking place. The inspectors did observe poor manual handling practice taking place in the communal room whilst staff transferred a service user from a wheelchair to an armchair, not only placing the service user at risk but themselves. Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 17 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? 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 2 OP7 15 Standard OP7 Regulation 15 Requirement The Registered person will ensure that where a care need is identified that a care plan is in place to support the care need. The Registered person will ensure that pressure risk assessments are completed correctly. The Registered person will ensure that evidence of sufficient fluid intake is monitored and recorded for service users at risk of not drinking adequate fluids. The Registered person will ensure that care charts are kept up to date and reflect the care provided. The Registered person will ensure the stock medication is kept at a reasonable level. The Registered person will ensure the homely remedy policy is inclusive of all homely medications which is stored in the medication cupboard and is agreed by the GP. The Registered person will ensure that all prescribed creams are stored safely. DS0000047880.V261824.R01.S.doc Timescale for action 23/12/05 23/12/05 3 OP8 12(1a) 23/11/05 4 OP8 12(1a) 23/11/05 5 6 OP9 OP9 13(2) 13(2) 23/12/05 23/12/05 7 OP9 13(2) 23/12/05 Little Manor Nursing Home Version 5.0 Page 19 8 9 10 11 12 OP19 OP26 OP26 OP38 OP38 23(2b) 16(2k) 16(2j) 13(5) 13(5) The Registered Providers will ensure that the en suite of bedroom 8 is refurbished. The Registered person will ensure that all bedrooms are kept free from offensive odour. The Registered person will ensure that unoccupied rooms are sufficiently cleaned. The Registered person will ensure that safe manual handling practice is observed. The Registered person will ensure the manual handling policy is reviewed and relates to current good practice. 23/01/06 23/12/05 23/12/05 23/11/05 23/12/05 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 OP8 OP9 OP38 Good Practice Recommendations The Registered person should consider revising the amount of protective sheeting used in beds. The Registered person should ensure that all dressing are stored safely and not placed in various areas of the home. The Registered person should consider employing weekend cleaning staff. Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Little Manor Nursing Home DS0000047880.V261824.R01.S.doc Version 5.0 Page 21 - 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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