Inspection on 18/11/08 for Manchester Court

This inspection was carried out on 18th November 2008.

CSCI found this care home to be providing an Adequate service.

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 07/11/07

Manchester Court 03/01/07

Manchester Court 21/06/06

Manchester Court 17/03/06

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

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Manor Lodge

Fairfields Country Rest Home

Poldhu

Queensmount

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Manchester Court 77 Clarence Street Cheltenham Glos GL50 3LB Lead Inspector Mr Tim Cotterell Key Unannounced Inspection 10:00 18 & 19th November 2008 th 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.V373237.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. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 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 nick.yorke@btinternet.com Raynsford Cheltenham Limited Miss Chloe Catherine 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.V373237.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to he home are within the following categories: Old age, not falling within any other category (Code OP) Mental Disorder, excluding learning disability or dementia (Code MD) The maximum number of service users who can be accommodated is 20 7th November 2007 2. Date of last inspection 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. The charges of the home are in the range £286-£440 per week and there are no additional charges. The home has a Statement of Purpose and a Service Users Guide and they provide the information which is required for new and existing service users The home will ensure that service users are kept up to date by providing them with the most recent inspection report. There is a notice board in the home and minutes of the service users’ meetings are available. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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. One inspector undertook the inspection over two visits. The first visit for a whole day the second visit for half a day. During the inspection the registered manager and the staff on duty were seen individually, together with the majority of the 19 residents who were living in the home. We looked at the accommodation, some care plans and the records for the management of medication. We also saw details of the last staff recruitment and two records of the personal allowances, which were being held and managed by the home. At the time of the inspection some rooms were being refurbished/redecorated and the maintenance person showed us some examples of his work and was clearly anxious to provide a high standard. Two completed surveys were returned to us one from a member of the care staff and one from a resident. We found the atmosphere in the home relaxed although staff did not appear to have time to provide an unhurried service in the morning due to the many and varied demands placed on them at this time of peak activity. We would hasten to add that we felt that staff had a good knowledge of the needs of the residents together with a good relationship. This was clearly evident during the many exchanges seen during our visits. What the service does well: The home accommodates people with a wide range of needs and staff were seen to have a positive relationship with them. The residents’ meetings provide a good avenue for comments and ideas and residents welcomed this opportunity. We saw staff prepare two main meals and we felt that this was done in a professional manner and a process which took account of personal preference e.g. for meal sizes. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 Page 6 Responsible risk taking is encouraged and assessed and this results in residents enjoying activities outside the home. Where residents were fairly independent they had considerable control over how they spent their days. Their control could be extended if the times of meals were shown and also include a degree of flexibility over times of start and finish. 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. The summary of this inspection report can be made available in other formats on request. Manchester Court DS0000016498.V373237.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 Manchester Court DS0000016498.V373237.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The individual and flexible service can be improved when the advice and guidance of all health care professionals is known to staff. EVIDENCE: In view of the change of registered manager the Statement of Purpose of the home will need to be amended. We recommend that this document is checked to ensure it reflects the current practice and refers to the appropriate registration categories. A Local/Unitary authority funds all of the residents and there is an assessment of need completed by them before admission to a care home. A number of the residents were also provided with specific plans of care for various aspects of their lives by NHS Partnership Trust. The home also undertakes an assessment of need before admission and this is based on the “activities of daily living” model. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 Page 9 Whilst it can be complex to combine assessments it is essential that the care plan subsequently completed by the home incorporates the guidance/advice from other health professionals. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The plans of care are clear and meaningful and should result in individual needs being recognised and wherever possible met. Residents were being treated in a dignified manner where privacy is regarded by staff as an essential aspect of the care practices. EVIDENCE: We spent some time talking to the carer who has overall responsibility for the care plans. All residents now have a plan of care and there was evidence that this is normally reviewed monthly or more frequently if required. However, we noted that one “behaviour” plan was dated 8 November 2007, another Enhanced Care Plan was dated 3 January 2008 and there was no evidence of any subsequent reviews. We suggest that the outcomes or objectives of a specific plan are written in a measurable way, as this would enable staff to determine if that objective had been met. It may also be helpful if the individual key workers were trained to enable them to be directly responsible for the updating of care plans. This would hopefully give them a greater Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 Page 11 investment in the care planning process. Would you ensure that all Care Plans completed by the Partnership Trust are received and where appropriate incorporated in the homes plan. Staff were unsure about the frequency of the plans and in one case the last plan was dated January 2008. Some of the residents affected would be seen as vulnerable and it is essential that all guidance and advice is noted and acted on. There was a record of health care provided, however, in some cases the details of advice given was brief and in itself was meaningless for care planning purposes. An example of this was advice from the continence adviser; this should be recorded in a manner, which enables all staff to have full details of any continence strategy. We were pleased to note that letters from other health care professionals asking if some residents wanted a health care plan were being dealt with in consultation with the residents as they were received. The records for the receipt, administration and disposal of medication was seen There is a record of all administrations and a weekly audit of all medicines that are held. We were advised that staff who administer medication are trained and competent. The current guidance from the Commission recommends up to three levels of training and additionally confirmation by the registered manager that the trained staff are competent to administer the medication. Any training provided should be accredited. There was no self-medication at the time of the inspection; however, the home has purchased lockable lockers for the bedrooms to prepare for this eventuality. The dispensing pharmacy provides a service for the home and all medication is reviewed either by the doctor or in some cases the consultant psychiatrist. Staff were seen to respect residents when providing care and the service was given in a dignified manner and where appropriate privacy provided. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to maintain contact with families and enjoy a degree of flexibility in their daily lifestyles. If residents had more information about meals/mealtimes it would enable them to exercise greater choice. EVIDENCE: Residents told us that they have a flexible lifestyle, however, the menu which is on display in the dining room, seems to suggest breakfast is only served at 08:30, there is no mention of the latest time you can have this meal. We accept that some residents do have a later breakfast but for those residents who are unsure some clarity about times would be seen as helpful. The view of the flexible lifestyle was questioned by one resident who told us that he was sent back to his bedroom as he arrived for breakfast before 0830 being told he was too early. We conveyed this incident to the manager who said she would investigate the matter. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 Page 13 We saw one visitor but it was evident from our discussions with staff and residents that visitors and friends are welcome and that if appropriate staff are helpful in maintaining positive relationships between residents and families. We were told that a volunteer provides some activities to include bingo, visits to social clubs and the monthly residents meeting. One resident told us that they go out to the local college for Art lessons and we were able to see some of his completed work. Staff also provide some one to one activities but this was seen as limited due to the other pressures on care staff. Care staff duties include meeting individual needs (caring) and they are also allocated ancillary duties, which include cooking, cleaning and laundry. The main meal of the day was seen during its preparation and delivery and it was presented in what residents saw as an appetising manner. Residents told us they had enough food and could ask for more if they wished. We were told that the menus for the main meal runs on a weekly cycle so that they felt residents knew what was for lunch each day and therefore could if they wished ask for an alternative. We asked a number of residents on both days we visited what was for lunch and the majority were unsure. If this is the case residents not knowing what was for lunch were disadvantaged in the context of making a choice and some said that they accepted what was given. We recommend that the main meal each day is indicated on the menu board in the kitchen together with the alternative(s), this would enable an informed choice to be made. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff will have a greater understanding of the various forms of abuse and the principles of practice to avoid abuse when further training is undertaken EVIDENCE: We spoke to a number of residents about the monthly residents’ meetings and they felt this was an opportunity to make comments and suggestions. It is important that the matters raised and discussed are brought to the attention of the manager who ensures that any requests are answered without delay. We say this as a minority of residents said that some of their requests were unanswered. This development may improve the transparency of the meetings. The lack of independent advocacy for those who do not have anyone outside the home should be addressed as some may have difficulty ensuring their legal rights are protected. During the inspection one resident came to the office and asked the manager about the arrangements for burial after her death. We were told that the matter is sensitively raised with residents and that their wishes are recorded. The manager has already identified the need for staff to undertake POVA training and told us that would be arranged in 2009. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home responds to environmental demands in a reactive manner, if they were more proactive the environment would be maintained to a better and more appropriate standard. EVIDENCE: We saw most of the accommodation with the new manager, the exceptions being a few bedrooms, which were, occupied and where residents were not able to see us. The ground floor lounge has been refurbished, to include decoration, new wall lights and some wooden wall fittings. A number of easy chairs have also been replaced. Whilst the carpet is not very old it is stained and should be cleaned without delay. We recommend that a regular cleaning schedule is devised to avoid a repetition. The window sash on the rear window is broken and must be replaced. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 Page 16 The dining room has been repainted and new lights fitted. The question of the suitability and condition of the dining room chairs was raised and we felt that a number of the chairs were not appropriate for older people i.e. they offered no arm support when residents were sat down. The table clothes were worn and stained and replacement is recommended. The fire door leading to the corridor has been damaged and should be repaired/replaced. The lounge on the first floor needs decorated as the wallpaper is faded and the ceiling requires repainting after the recent electrical installations. The stairway wall between the ground and second floors are stained and require repainting/repapering. To avoid carpets becoming badly stained we recommend that the manager or a senior designated person inspect all the carpets on a regular basis. The entrance to the rear of the home has been improved by the installation of a ramp from the car park to the patio area and residents told us that this means they are able to have easier access to this area. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have a good relationship with the residents but would be better placed to meet individual needs if they were able to concentrate on direct care duties throughout their shifts. EVIDENCE: During the inspection we saw many interactions between staff and residents and it was clear there was a positive relationship between them and that staff were providing a flexible service which attempted to meet their individual needs. We met the NVQ assessor for a number of staff who were undertaking NVQ level 3 studies. The assessor told us that staff were committed to their studies and that their assignments were meeting the required standards. We discussed the adequacy of staffing with the manager. We were informed that the levels had been reviewed earlier this year but the findings were not available. The manager however felt that the staffing levels were sufficient but has agreed to undertake a formal review the findings of which we would have sight of. We were particularly concerned with the adequacy during the mornings which is a time of high demand on staff and in the evenings when there are only two carers on duty Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 Page 18 We only received one completed “Commission survey” from staff and whilst we were disappointed we accept that the return was a matter of choice. The staff member said that they met the manager monthly for staff meetings and that personal supervision was also given. They felt that Manchester Court provided a good service and they could not suggest any improvements. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. We understand that the new manager will form part of the normal shift patterns with other care staff and it is felt that this will improve the delivery of personal care. EVIDENCE: The new manager is now registered but awaiting her certificate of registration. We were informed that the new manager will be more “hands on”, meaning that she will form part of the shift system and this will allow her to work with and see other staff more often. Whilst the new manager is now responsible for the day-to-day management of the home the previous manager remains a director of the company who are the registered providers. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 Page 20 The new manager does not intend to change the philosophy of the home and told us that the care practices will continue to reflect the wishes of the residents and confirmed that they will still be consulted over how the home is run. We discussed the need for POVA training for staff and this is being arranged. We also discussed the role of advocates for residents who do not have any relatives/friends and also the purpose of the Mental Capacity Act 2005. We recommend that the home considers the use of independent advocates for some residents and this is something that could be discussed with the advocate agency direct. A number of financial records were seen and we looked at a record of the receipt and expenditures for the personal allowances of the residents. It is essential that when money is used by staff to purchase items for residents a receipt is obtained and held with the records, ideally with referencing between the withdrawal and purchase. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 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 3 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 Page 22 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 YA1 Regulation 4 Requirement The registered person must review the Statement of Purpose to ensure it reflects the recent changes in management, the purpose of the home and the categories of care which can be accommodated. The registered person must repair the fire door that leads to the dining room to ensure it is fit for purpose. The registered person must, a) ensure there are sufficient staff on duty at all times to meet the needs of the residents and, b) send to this Commission a copy of the staff review which is to be completed by the Registered Manager. Timescale for action 31/01/09 2. YA42 23 [4] 31/01/09 3. YA33 18 31/01/09 4. YA24 23 The registered manager must 28/02/09 ensure that the work identified in the environment section is undertaken. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 Page 23 5. YA6 15 The registered manager must ensure that all plans of care completed by the NHS Partnership Trust are received and incorporated in the plan of care completed by the home. 31/01/09 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 YA24 YA8 Good Practice Recommendations We recommend the replacement of tablecloths and dining chairs. We recommend improving communications between the home and residents in respect of residents’ meetings i.e. record actions resulting from requests by residents. Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Manchester Court DS0000016498.V373237.R01.S.doc Version 5.2 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. 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