Inspection on 24/07/06 for Little Manor Nursing Home

This inspection was carried out on 24th July 2006.

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 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 23/11/05

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 Key Unannounced Inspection 24th July 2006 09:20 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.V303395.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. Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 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 Vacant 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.V303395.R01.S.doc Version 5.2 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 in application dated 20/03/06 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 23rd November 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. Two communal rooms are provided which over look 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 Acting Manager Asha Tones RGN is currently managing the home. Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for the Key inspection took place 24th July 2006 commencing at 9.20am. The Acting Manager Asha Tones was available to assist the inspector. The inspector was able to freely tour the building, visit with many service users and observe staff interacting with service users and attending to their care needs. Prior to the site visit-taking place, the inspector sent five service users surveys to the home to gain the opinions from the service users regarding the service provided by the home. Five surveys were returned which were positive. The care of five service users was case tracked through the inspection process by reviewing care records, observing care and speaking where possible to the service users. The inspector spoke with many service users who were all generally complimentary of the care provided. The Acting Manager and staff were open to the inspection process and helpful throughout. The home had met all the requirements set from the previous inspection. Only one requirement was set following this inspection and five good practice recommendations. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Little Manor provides a homely environment for service users to live in, mainly due to the size of the home and the homely furnishings and décor. The bedrooms are personalised and the home is clean. The garden is very well maintained and provides a lovely area for service users to sit outside during the summer months. The nutritional needs of the service users are monitored and a good standard of food is provided. Service users are supported to retain links with family and friends. Service user’s, who were able to communicate, confirmed that they are provided with choice during the day and do as they wish. Frail service users are provided with the opportunity to spend part of the day out of bed with appropriate equipment in place to support their needs. Little Manor Nursing Home DS0000047880.V303395.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. Little Manor Nursing Home DS0000047880.V303395.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 Little Manor Nursing Home DS0000047880.V303395.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): 3 An admission procedure is in place and a full pre admission assessment takes place for all prospective service users. The home is not registered to provide intermediate care. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: All prospective service users are assessed prior to admission to Little Manor Nursing home to ensure that through the assessment process the home is able to meet the nursing care needs and social needs of the service users. Mrs Pauline Airey (Provider) or Sally Bellinger (Consultant Nurse Manager) conduct the pre admission assessments. The inspector reviewed two pre admission assessments. Both assessments were detailed providing information of current health care needs and long term needs. A record of the assessment is kept on the service users file and used towards implementing a care plan. The home is not registered to provide intermediate care therefore Standard 6 is not applicable to this service. Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 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 Health care needs of the service users are monitored and appropriate action taken when health care needs change. The care records have improved, now providing full information of the care needs of the individual service user. The care team fully support the dignity of the service users. Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Five care plans of service users who were identified as having high needs whilst the inspector toured the building were reviewed as part of case tracking the care provided by the home to the service users. The care plans had much improved since the previous inspection regarding the detailed content of care needs documented. Care needs had clearly been identified and care plans were in place to support the care need. Appropriate risk assessments were in place, such as falls risk assessments and pressure damage risk assessments. Manual handling risk assessments were complete and gave clear instructions how to manage the service users mobility needs. Evidence was available of care Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 Page 10 records being reviewed monthly and when the care and medical needs of the service user change. All service users are registered with a local GP. A record of the GP visit is maintained. Health care needs are monitored and records were maintained when other health care professionals were contacted or visited the home. A Very frail service user was observed spending part of the day out of bed supported with appropriate nursing equipment to do this. Service users who were able to communicate were satisfied that their health care needs were being met. Service users with higher needs had care charts in place to record care provided and dietary intake. The care charts were monitored at various times during the course of the inspection, each time the care charts were up to date. Manual handling procedures have much improved for those service users requiring assistance to transfer with the use of transfer lifting belts and hoists, reducing the risk to service users and staff. The medication procedure was seen which was assessed as safe. The medication records were complete and up to date. All medication was stored correctly inclusive of controlled medications. The controlled medication register was correct. The disposal of medication was in line with current legislation. Seven service users confirmed with the inspector that all nursing and personal care was provided in the privacy of their own bedroom or in the bathroom. This was also observed taking place whilst the inspector toured the home. The care staff were observed and heard interacting with the service users in a friendly but respectful manner. Service users also confirmed with the inspector that they were spoken to by the staff with respect. Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 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): 12, 13, 14 and 15 The activities programme provided supports the social needs of the service user group. Service users are supported by the home to retain links with family and friends. Service users are provided with choice and control over their lives as far as possible within the framework of a nursing home. Service users were satisfied with the food provided and nutritional needs are monitored. Quality in this outcome area is judge to be good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Wessex Care Ltd provide a small team of activities co-ordinators which provide social activities and one to one sessions to service users between the three care homes owned by Wessex Care Ltd. The three homes are in close proximity to each other. An activities co-ordinator was visiting Little Manor during the morning of the inspection providing one to one visits, as many of the service users are unable or do not wish to participate in group activities. Service users were observed spending time in the privacy of their own bedroom, reading or watching TV. When asked by the inspector they confirmed that this was their choice. Other service users were observed spending time in one of the two communal areas or sitting outside in the garden. Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 Page 12 Service users are supported by the home to maintain links with family and friends. Visits from families were observed taking place and the visitors signing in book provided evidence that family and friends may visit the home at any reasonable time. The inspector was invited for lunch, which was well presented and nicely cooked. Service users were generally complimentary of the meals provided. The menus were seen which were varied. A discussion took place with the cook who reported that she would change the menu to suit the needs of the service users if needed. The home provides specialised diets for those service users requiring low salt or a diabetic diet. The puree meals are as well presented as possible. It was observed though that providing the lunchtime meal to each service users took along time. The inspector observed 4 service users having lunch in the dining room but they did not receive their meals at the same time and a service user did become a little agitated whilst waiting for her lunch. It will therefore be recommended that a review take’s place of the lunchtime procedure. It will also be recommended that service users are provided with a weekly menu, as when asked service users could not remember what they were having for lunch. The kitchen was seen which was clean and organised. Plans are in place to refurbish the kitchen. Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): A complaints policy and procedure are in place. The Management team are fully aware of how to deal with any allegation of abuse. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: A complaints policy and procedure is in place, which is clearly displayed in the entrance hall of the home for service users and families to easily access. Mrs Airey also informed the inspector that three monthly relatives meetings are now held which provides a good opportunity for relatives to raise any concerns or complaints relating to the service provided by the home. Minutes of the last meeting recently held were seen. An “Abuse Awareness” policy is in place and the Manager is fully informed how to deal with any allegation of abuse should this occur through the local vulnerable adults procedure. Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Little Manor is a well-maintained home offering a homely and safe environment for service users to live in. The bedrooms vary in shape and size with many having an en-suite facility. Infection control measures are in place. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a site visit. EVIDENCE: Little Manor is an older building, which has been extended overtime offering a range of accommodation. In the older part of the building the bedrooms vary in shape and size. Two communal rooms are provided both of which have small dining areas. The current providers have refurbished throughout the home. The home is well maintained and provides a homely environment. To the side of the home a well maintained garden with some bedrooms having access to the garden via patio doors. A full time maintenance person is employed. Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 Page 15 Many of the bedrooms were visited which were well furnished and personalised depending on the preference of the individual service user. Service users who were able to communicate were complimentary of the accommodation provided. The majority of bedrooms are provided with en-suite facilities. The home was found to be generally clean through out with two domestic staff on duty. The communal bathrooms and toilets were clean. Infection control measures were in place and the staff was observed wearing appropriate clothing and disposable clothing for specific duties. The laundry facility was seen which was organised and clean. Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The staffing levels operated are in line with the “Staffing Notice”. The staffing levels met the care needs of the service users during the day. The employment records of two members of staff were not complete. All mandatory training is provided. Quality in this outcome area is judged to be adequate. This judgment has been made using available evidence including a site visit. EVIDENCE: The home was caring for 25 service users requiring nursing care. The home was operating the staffing levels in line with a condition of registration and in accordance with the number of service users. Two qualified nurses were on duty, one of which was the Acting Manager. The trained nurses were supported by a team of five carers. The home was calm and well organised. The care needs of service users were being dealt with during the busy morning period of the home in an appropriate amount of time. Service users reported that most of the time call bells were answered quite promptly. It is recommended that the Providers do review the night staffing level, ensuring that the level of staff provided is suitable to meeting the night care needs of the service users. It was noted that 13 service users required night medication leaving only one carer to provide care whilst the trained nurse provided the medication. The recruitment files of 4 members of staff were reviewed. Whilst appropriate police checks had been made, two staff members from over-seas did not have Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 Page 17 adequate references, providing evidence that they were suitable candidates for the post. All staff had been provided with mandatory training. The home management team supports and encourages NVQ training which some of the care staff have now obtained. Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 Page 18 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 assurance systems are in place ensuring that the views of the service users are obtained. The home is well maintained providing a safe environment for service users to live in. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The Acting Manager, Asha Tones, has not yet been registered with the CSCI. It was agreed at the inspection that Asha would supply the CSCI with a completed registered managers application on her return from annual leave in September 2006. This standard will therefore be fully assessed at the next inspection. A quality audit system is in place ensuring that the views of the service users and relatives are taken into account, regarding the service that the home Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 Page 19 provides. The three monthly relatives meetings, which are now held also provide an opportunity for relatives to comment on positive aspects of the service provided or raise any concerns. The home is well maintained throughout providing a safe environment for service users to live in. Health and safety issues are addressed. The fire records indicated that all appropriate testing of the fire alarm system was taking place and staff had received fire training. Accidents had been recorded as to how the accident had taken place and what action had been taken by the home following the accident. The manual handling procedures observed had much improved with appropriate equipment provided ensuring the safety of service users and the staff. All staff had received manual handling training. Electrical equipment is checked annually. The garden is well maintained with good access for wheelchair users. Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 Page 20 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 3 Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 (Schedule 2) Requirement The Registered Person will ensure that two written references are obtained prior to employment. Timescale for action 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP15 OP15 Good Practice Recommendations The Manager should consider introducing weekly menus for the service users to ensure that the service users are informed of what meal is provided for the day. The Manager should review how the meals at lunch time are served ensuring service users who are sitting together receive their meals at the same time to create a more social event. The Manager should review the night staffing levels to ensure that the care needs of the service users are met by the staffing level provided. 3. OP27 Little Manor Nursing Home DS0000047880.V303395.R01.S.doc Version 5.2 Page 22 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.V303395.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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