Inspection on 17/03/06 for Manchester Court

This inspection was carried out on 17th March 2006.

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

Manchester Court 18/11/08

Manchester Court 07/11/07

Manchester Court 03/01/07

Manchester Court 21/06/06

Manchester Court 30/08/05

Manchester Court 14/03/05

Manchester Court 03/11/04

Manchester Court 26/03/04

Similar services:

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Fairfields Country Rest Home

Poldhu

Queensmount

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

CARE HOMES FOR OLDER PEOPLE Manchester Court 77 Clarence Street Cheltenham Glos GL50 3LB Lead Inspector Mr Tim Cotterell Unannounced Inspection 17th March 2006 10:00 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 Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 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. Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Manchester Court Address 77 Clarence Street Cheltenham Glos GL50 3LB 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) 01242 523510 Raynsford Cheltenham Limited Mr Nicholas Allan Yorke Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10), Old age, not falling within any of places other category (10) Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd September 2005 Brief Description of the Service: Manchester Court is a listed building in the centre of Cheltenham. It is near to the town centre with all its amenities, and central library and museum are a hundred yards away. The Parish and Roman Catholic churches are near by. Accommodation is on four floors. The kitchen, laundry and some storage areas are in the basement. On the ground floor is the communal dining room and lounge. A shaft lift and stairs serve all residential floors. The bedrooms are located on all floors and are for single occupancy. There are no ensuite facilities, although washbasins are provided in each room. There is level access to the rear of the building, which opens onto a courtyard with some adjacent car parking spaces. The front door has three steps down and opens directly on to Clarence Street. Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection completed in one day by two inspectors. The registered manager and care staff on duty were spoken to. All the service users were seen and the majority spoken to individually. The environment was inspected, and care and medication records were looked at. The home has made improvements since the last inspection and this included the proposed care planning system and also the physical environment which had been improved in some areas. The issue of staff training for mental health needs was discussed and the question of appropriate training and how this can be achieved will be raised by the inspector with NHS Partnership Trust at Charlton Lane. At the time of the inspection there was no formal training in this area. It was evident that there was a good relationship between health care professionals and the home however it was felt that the assessments and plans of care were not part of the operational plans within the home. In some case staff had limited `knowledge of the important aspects of the health plan which had been completed by the Community Nurses. Community health care plans must be incorporated in the homes operational plans of care. What the service does well: There is little doubt that staff make great efforts to provide a home for a group of people who have a wide and demanding range of needs. The service users live in a relaxed atmosphere where they are able to exercise choice over how they spend their day. However the differing needs and behavioural patters of some advisedly affects the wellbeing of others. The registered manager is now undertaking NVQ4 studies and it is hoped that the training will help in the management of the staff and care of the service users. Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: All care plans must be recorded correctly and additions made to ensure service users needs are met. Medication administration records must be completed correctly to protect the service users. Ensure that all bedrooms have adequate heating by visiting the rooms frequently. All bedrooms to have at least two double electric sockets to ensure service users are able to use their electric appliances safely. All care staff must have relevant training in the mental health needs of the service users whose mental health care needs are the predominant “disability”. Please contact the provider for advice of actions taken in response to this Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 8 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 Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 9 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 The information provided enables prospective service users to make a decision about whether the home can meet their needs. EVIDENCE: The Statement of Purpose has now been amended. The registered manager agreed to place a lower age limit on new service users who were in the category of mental disorder. The original registration category states that the age range is 18 to 65 whereas the registered manager has through agreement limited this to admissions for service users who are over 50 on admission. The purpose of the change is to make the two groups who can be accommodated in the home, (older persons over 65 and mental disorder 18 to 65) more compatible in the context of their respective age ranges. The assessment of need heading should indicate that it refers to Manchester Court. Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 The care staff had devised an improved method of recording the care plans and had completed one sample. This was incomplete and additions are required to ensure all the service users needs are met. There were errors in the medication administration records which must be completed correctly to protect the service users. EVIDENCE: A new format for recording care plans had been devised and kept in a ring binder folder where all relevant letters etc. from healthcare professional were also stored. Thai’s made access easy and ensured all information was to hand when required. Assessments had been recorded for activities of daily living and a basic care plan had been produced. There was room to improve the standard of the recording in the care plan to ensure that the needs identified in the assessments had detailed actions for care staff to follow. There was a need to record night time care, particularly for one service user who was often up during the night and may disturb other service users. Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 11 The care staff were unaware in some cases of the service users medical/psychiatric health needs. Without this knowledge it is difficult to identify what actions may be appropriate. Care staff will need appropriate training to be able to ensure that the diverse needs of the service users can be met. The manager stated that the Community Psychiatric Nurse helps to train staff in mental health needs when they visit the home. An informative social history for each service user should be recorded, with consent, to ensure that previous interests and preferences can be continued in the home. One male service user spoken to would like the opportunity to go out with male staff more often, and would like more to do in the home. It is recommended that healthcare professional visits to service users or their visits to the hospital etc. are recorded separately, to include the reason and outcome, this will to enable staff to plan any support or intervention. It was evident that healthcare professional visited the home as seen in the daily records. The daily records were well recorded and included incidents that may affect the wellbeing of the service users and the consistency of their care. The Commission should have been notified about some incidents under Regulation 37. Most of the service users spoken to felt well cared for by the staff. The home has a medication administration procedure and some staff had completed a distance learning medication course through a local college. The manager stated that there was also medication training the following day, provided by the supplying pharmacist for all staff who administer medication. Medication training should be accredited to ensure a good standard of administration is achieved. Medication administration was inspected and there was an error discussed with manager for medication prescribed regularly by the hospital. This must be rectified to ensure that the Medication Administration Record sheets compiled by the pharmacist are correct. It is recommended that the GP review this method of prescribing. Some transcribed medication had not been signed which is not good practice. Allergy boxes were not complete on the MAR sheets. Some ‘when required’ medication e.g. Haloperidol must have a care plan indicating a protocol for administration, this was not evident during the inspection. The medication was safely stored and a new cabinet had been purchased to ensure that any controlled medication can be correctly stored. One new service user self medicates insulin and is well supported by the home. Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 12 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): Not inspected EVIDENCE: Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 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): 16 18 The home must investigate incidents that are recorded in the daily notes and take appropriate actions to include advising the Commission of certain events EVIDENCE: Service users have a written complaints procedure however it was clear that they were usually able to bring their concerns to staff before any formal process was necessary. The issue over adequate seating in the dining room provided contradictory evidence of staff responding to issues raised. The service users raised the issue at a meeting the fact was recorded but the registered manager did not seem aware that it was an issue and therefore at the time of the inspection no action had been taken. The concern was that there were not enough dining chairs for all service users to sit and eat in the dining room. The home must now inform the Commission of the procedure for dealing with requests/concerns raised at the service users meetings The service users meet as a group with a volunteer who visits the home and they have regular service users meetings. One topic at the meeting on 3 March 2006 was the complaints procedure and this was read to the group. The majority of service users would not be able to use the complaints procedure without support and it is essential that staff are updated in respect of their role in relation to complaints. The Commission had requested information in respect of the new care planning system and this included daily records. A number of the records included what Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 14 were seen by the Commission as incidents which are subject to the reporting procedures of regulation 37 (1)(e). This requires the home to advise the Commission of “any incident which affects the well being or safety of any service user”. There is no record of any notification of the incidents on the daily log sheets. We refer specifically to the entries dated8 January 2005 24 April 2005 1610 (two entries) and 1740 We would also like to know who made the entries on the following dates and in what capacity they were acting24 February 2005 13 April 2005……………. 0245 and 0745 Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 15 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 25 26 Whilst the home has made a number of improvements there continues to be areas, which require attention. The inadequate heating in some of the bedrooms places the vulnerable service users at risk EVIDENCE: There have been a number of improvements since the last inspection. This included new carpeting in a number of areas, the installation of a new bath on the ground floor and some decoration. A number of bedrooms provide a pleasant environment and staff have supported service users when they have personalised their rooms. However some matters require attention they are as followsManchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 16 Communal Areas The lounge and dining area require new and more appropriate furniture We are particularly concerned over the ability for the older person to use the chairs and settees and be comfortable. The downstairs lounge and dining room do not have sufficient chairs for all service users and the inability to use the dining room was raised with the inspectors. (Lounge has 14 and dining room 16). The lounge on the first floor requires decoration as the walls are stained. Bedrooms Room No 31- the lock of the bedroom door did not allow the door to be opened or closed easily as the handle was away from the frame. The inspectors were informed that he had been repaired recently but it was not working on the day of the inspection. The curtains in bedroom 28 were not secured to the rail and looked unsightly. A number of bedrooms have one power point and this was clearly inadequate in view of the number of appliances being used. A number of service users were using multiple extensions, which resulted in one area of the room being potentially dangerous with the number of leads on the floor. There must also being a number of safe places to keep appliances, rather than them being held on the floor, safety must be a priority then easy access. Standard 24(2) National Minimums Standards states that” there are “ at least two accessible double electric sockets. A number of bedrooms were described as cold by service users and the attention of the registered manager was drawn to bedrooms 32, 28, 18 and 11. It is a requirement that service users enjoy a temperature of their choice and that they have the ability to regulate this. The temperatures of these rooms will be tested by a calibrated thermometer at the next visit. In bedroom 18 the temporary chain lock must be discussed with the Fire Officer to ensure it is seen as safe. The room also requires decoration as the walls and ceiling are stained. The easy chair in bedroom 17 was broken. The carpet in bedroom 3 is stained and must be cleaned/replaced Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 17 Bathrooms/Toilets Third Floor The toilet bowl on the third floor was badly stained the cleaning rota indicated that it had been cleaned that morning. The bath/wc room there was no back on the toilet some tiles were broken and the walls and ceiling were stained. The flooring had been replaced. Second Floor The bathroom on the second floor has loose skirting board covering and this is a potential danger for the feet/legs of service users. First Floor The bathroom on the first floor has a cracked and damaged ceiling. Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 18 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 inadequate staffing levels results in service users being at risk. EVIDENCE: The last inspection report indicated what was seen by the Commission as being a minimum (page 21 report dated 30 August 2005). The registered manager informed the inspectors that the home was working towards meeting this minimum and that there were just a few shifts to cover and the minimum would be met. The minimum figures will be required from the date in the requirement section of this report. Failure to meet this would result in formal action in the circumstances your urgent attention is requested. The staff rota sent to the Commission does not indicate the duties of ancillary staff it is therefore not possible to determine if the staffing level meets the minimum requirements’. The inspector confirmed that staff records must be kept in the home. The home is required to forward copies of the staff training profiles this applies to all staff. Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 19 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 Service users are not fully protected without a written risk assessment of the building. The health and safety of service users are compromised with the present staffing levels. EVIDENCE: There was no evidence of any risk assessments in respect of fire and it is recommended that you contact the Fire and Rescue Services if you need advice on this matter, the assessment is a requirement under “health and safety”. The registered manager has enrolled on the NVQ course recommended by the Commission (please see Standard 31(2) of the National Minimum Standards) and will commence in April. The registered manger has applied to become the responsible individual a position required if the providers are an organisation. Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 20 In principle we are happy with the proposal but it would be subject to the organisation ensuring that Regulation 26 visits “visits by the registered provider”; in this case Regulation 26(2) sub section (c) would seem appropriate. That is the visits must be undertaken by an employee of the organisation who is not directly concerned with the conduct of the care home This would by definition exclude the two directors, which include the registered manager. The registered manager raised the issue of smoking in the home. As the home admits service users who smoke they will have a duty to provide somewhere that is designated for this purpose and away from non-smoking areas. There is also a responsibility under the employer/employee relationship and it is recommended that you seek specialist advice (e.g. the insurers which underwrite your Employers Liability Insurance). Staff must not be permitted to smoke in the non-smoking areas of the home. The registered manager asked for some evidence of the increased requirement for staffing. It is suggested that the last report (30/08/06) together with the present one is passed to any enquirer as they indicate that minimum standards are not being met and requirements are now being made to increase the levels. The inspectors also discussed the mix of categories (mental disorder and older persons). The home is registered to accommodate up to ten of each category and the Commission now requires a list of service users and their respective categories. The inspectors were concerned over the ability of the home to meet the needs of what were seen as a disparate group with a range of complex and diverse needs. It is recommended that the organisation which provided the service (the company which runs the home) consider the options available. which will of course include the home continuing without change. Other options include gradually increasing either category to meet new needs and enable staff to concentrate on a smaller range of needs. This would mean more emphasis on the ageing process, if older people were the priority and perhaps mental disorders to include challenging behaviours if the other category was favoured. Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 21 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 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 2 2 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 2 X 2 X X X X X Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 22 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 Standard OP3 OP7 Regulation 14 15 12 12 12 12 12 18 Requirement The assessment of need must clearly indicate that it refers to Manchester Court All care plans to be completed. Care plan assessment to have detailed day/night action plans Health Care needs must be recorded and in a separate form Medication records must be maintained correctly Ensure medication training is accredited Ensure doctor review one method of prescribing (see report) As required medicines require individual protocols The home must meet the minimum staffing level as indicated in the report dated 30 August 2005 The home must complete a written risk assessment on the building The home must nominate the person who will undertake Regulation 26 visits Timescale for action 11/05/06 30/06/06 30/05/06 17/03/06 30/05/06 30/05/06 30/05/06 30/06/06 2 3 4 5 6 7 8 OP8 OP9 OP8 OP8 OP8 OP27 9 10 OP38 OP31 23 26 30/06/06 15/06/06 Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 23 11 OP25 23 The home must maintain sufficient heating to ensure individual needs are met Sufficient ands appropriate lounge/dining room furniture 15/07/06 12 13 14 OP20 OP20 OP33 23 23 12 01/08/06 Complete all identified areas in 01/08/06 the physical “environment”(pages 17/18 of the report) Inform the Commission of the 01/08/06 procedure for the action of issues raised at the service users meetings. Inform, Commission of the details requested on page 15 of the report 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 OP27 OP30 Good Practice Recommendations The home must submit a complete staff rota The home must submit staff training profiles Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Manchester Court DS0000016498.V286831.R02.S.doc Version 5.1 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!