Inspection on 09/06/05 for Little Manor Nursing Home

This inspection was carried out on 9th June 2005.

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 24/07/06

Little Manor Nursing Home 23/11/05

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 9th June 2005 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 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 D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Little Manor Nursing Home Address Manor Farm Road Salisbury Wiltshire SP1 2RS 01722 333114 01722 336933 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Wessex Care Ltd Mrs Jeanette Roselyn Cook Care Home with Nursing 26 Category(ies) of OP Old Age (26) registration, with number TI(E) Terminally ill - over 65 (2) of places Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users who may be accommodated at any one time is 26. 2. No more than 2 service users aged 65 years and over with a terminal illness may be accommodated at any one time. 3. Only the one, named service user, currently in residence in the home may be under 65 years of age. 4. The staffing levels set out in the Notice of Decision dated 20 July 2004 must be met at all times. Date of last inspection 13th January 2005 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 D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced at 10.30am and was completed at 3.30pm. The inspector toured the building with either the Registered Manager or the Clinical Nurse Manager. During the tour the inspector was able to visit with many of the Service Users and talk to visitors. Care records were reviewed as were the medication procedure. What the service does well: What has improved since the last inspection? Most parts of the home have recently been refurbished. However the refurbishment programme continues. A shared room has been refurbished since the last inspection, which had much improved and now provides the Service Users with an assisted en-suite facility. The staff now receive regular supervision and staff training files are in place. All staff are up to date with Manual Handling training. Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 Page 6 The daily statement recorded for each Service User is more detailed and personalised. The Registered Manager regularly audits the accidents record, observing for any pattern in accidents. 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 D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 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 standard(s) 3 and 5 A clear admission procedure is in place and all needs are assessed during the pre admission assessment. Service Users and families can visit the home prior to admission. EVIDENCE: All Service Users are fully assessed by the Registered Manager or Mrs Airey (owner of the home) prior to admission to Little Manor to ensure that through the assessment process the home is able to meet the nursing needs and social needs of the Service User. The assessment is detailed providing information of all current health care needs and social needs. A record of the assessment is kept on the Service Users’ file. Service Users are encouraged and invited to visit the home prior to admission, to meet with staff and other Service Users. Due to poor health care needs pre admission visits do not always take place. Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 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 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 plans fully address all aspects of care. The privacy and dignity of the Service Users is supported by the care team. Not all medications were recorded or stored correctly. EVIDENCE: Each Service User is provided with a plan of care. The care plans are detailed and address current and long-term health care needs ensuring all care needs are fully identified and addressed. Monthly reviews take place or when care needs change. The daily statement recorded for each Service Users is now more detailed and provides general information of the Service Users daily activities and events. Two Service Users were seen without call bells, it was documented in the Service Users care plan they were unable to use the call bells. However care charts were not in place with the Service Users to provide evidence of when care staff made visits to the Service Users ensuring all needs are monitored. It was observed that the staff should pay more attention to hand care for those Service Users who are unable to take care of their own hands. Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 Page 10 All Service Users are registered with a local GP good written evidence was available of all GP visits and outcome of visit. Service Users who were able to communicate were complimentary of the care provided, as were two relatives the inspector spoke with. Health care needs are monitored and visits from other health professionals was seen. Service Users confirmed that any nursing or personal care always took place in the privacy of their bedroom or bathroom. This was also observed taking place during the inspection. The medication procedure was reviewed and the medication trolley was not found to be secured to the wall. The sample signature sheet and medication policy was not with the medication administration record. A medication, which is recommended to be recorded in the control drug register was not and was stored in the medication trolley not the controlled drug cupboard. The medication had not been signed into the building. Signature gaps were observed on the medication administration sheets. Hand written medication orders had not been signed by two members of staff ensuring the order was correct. Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 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 standard(s) 12, 13 and 15 The activities provided are appropriate for the Service User group. Service Users are supported by the home to retain links with families and friends. The food provided by the home is enjoyed by the Service Users. EVIDENCE: Activities are provided most days by the allocated activities person. The activities person is in the process of providing each Service User with an activities diary, which were seen in the bedrooms. Due to the high dependency of many of the Service Users one to one visits take place, provided by the activities person, ensuring their social needs can still be met. Service Users who do not wish to attend activities reported they can do as they like and that the staff respect this. Service Users can receive visitors at anytime. The visitors signing in book confirmed this. The main hot meal of the day was well presented and Service Users reported the food as good. The home provides to dining areas. However many of the Service Users were eating in their bedrooms. Ten Service Users were requiring assistance with their meals, which was conducted by the care staff on a one to one basis. Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 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 standard(s) 16 and 18 There is a complaints policy and procedure in place. A vulnerable adults procedure is also in place and staff are fully aware of the local procedure and how to use it. 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 home investigates any complaint very well and evidence was available of the outcome of the complaint. Four Service Users confirmed that they would talk to the Manager if they had any issues or problems. 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. The staff are aware of the local vulnerable adults procedure. A “Whistle Blowing “ policy is in place. Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 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 standard(s) 19, 21, 24 and 26 Little Manor provides a homely and comfortable environment for Service Users to live in. The home is clean and infection control practices observed, apart from a piece of medical equipment. EVIDENCE: Little Manor is homely with domestic furnishings and décor throughout. The home has been through an extensive redecorating programme, which is now nearly complete. The home provides a clean and homely environment for Service Users to live in. Two communal areas are provided which are light and well decorated, both of which over look the well-kept gardens. The bedrooms are nicely decorated and personalised. Service Users who were able to communicate were complimentary of the bedrooms provided. The assisted bathrooms have not been refurbished yet and do not have the same homely feel as the rest of the home. However the inspector was informed that the bathrooms will be refurbished at the end of the year. Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 Page 14 The home was clean to a good standard throughout. Infection control measures are in place and staff were seen changing disposable gloves and aprons between Service Users reducing the risk of cross infection from one Service Users to another. However a suction machine seen in a Service Users’ bedroom was not clean, the suction catheter and tubing would not have been suitable to use in the event of an emergency. Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The number of staff available during the morning, do not appear to fully meet the care needs of the current high dependency Service User group. EVIDENCE: The staffing rotas seen provided evidence that a trained nurse is on duty day and night ensuring all nursing care needs can be met or assessed by a qualified nurse. The qualified nurse is supported by a team of carers who provided personal care to the Service Users. It was observed during the inspection a Service User was in bed waiting for care at 12.15am and was requesting to get out of bed. The staff were observed as busy trying to ensure all needs were being met. It will be recommended due to the high needs of the current Service Users that staffing levels in the morning should be reassessed, whilst the home is providing care for such a high dependency group. Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 Quality assurance procedures are in place, which gain the opinions of the Service Users and families. Health and Safety issues are addressed. EVIDENCE: The home has quality assurance measures in place. The Registered Manager informed the inspector surveys are now being sent to families and friends to gain their opinions of the service provided at Little Manor. The Providers hold Service Users and family meetings. The minutes taken from the last meeting were made available to the inspector. The home is well maintained throughout and Health and Safety issues addressed. All accidents are recorded and regularly audited. Electrical equipment is tested annually and servicing of hoists was taking place. The fire records showed the weekly testing of the fire alarm had taken place. Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 2 x x 3 x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x 3 Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 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. 3. 4. Standard OP8 OP9 OP9 OP9 Regulation 12 13(2) 13(2) 13(2) Requirement The Registered Person will ensure care staff assist Service Users with hand care. The Registered Person will ensure the medication trolley is stored safely at all times. The Registered Person will ensure all medication received into the home is recorded. The Registered Person will ensure all medication is signed by the nurse adminstering the medication on the administration record, if the medication is not given the reason for this will be documented on the back of the medication record. The Registered Person will ensure medical equipment is clean at all times. Timescale for action 1st July 2005 From the 9th June 2005 1st July 2005 1st July 2005 5. 6. OP26 23(2,c) 1st July 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Version 1.30 Page 19 Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc 1. 2. OP9 OP9 3. 4. 5. OP9 OP27 OP9 6. OP8 The Registered Person should consider storing the mediation trolley in the care office. The Registered Person should ensure that where medication intructions are completed by hand, that the record is signed and countersigned by a second member of staff. The Registered Person should store the Medication Oramorph in the controlled drug cupboard and record the medication in the conrolled drug register. Due to the current needs of the Service Users the staffing levels in the morning should be reassessed. The Registered Person should ensure the homes medication policy and procedure and the staff sample signature record is kept with the medication administration records. The Registered Person should consider having care chart monitoring records for those Service Users who are unable to use the call bell system. Little Manor Nursing Home D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 Page 20 Commission for Social Care Inspection Avonbridge House Bath ROad Chippenham Wiltshire, 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 D51_D01_S47880_LittleManor_V185504_260505_Stage4.doc Version 1.30 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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