Inspection on 16/11/05 for Manchester House

This inspection was carried out on 16th November 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

Manchester House 19/02/08

Manchester House 03/11/06

Manchester House 08/12/04

Manchester House 08/06/04

Manchester House 16/12/03

Manchester House 04/06/03

Manchester House 13/08/02

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Manchester House 83 Albert Road Southport Merseyside PR9 9LN Lead Inspector Mr Mike Perry Unannounced Inspection 16th November 2005 09:30 X10029.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 House DS0000017249.V266598.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. 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 House DS0000017249.V266598.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Manchester House Address 83 Albert Road Southport Merseyside PR9 9LN 01704 534920 01704 501053 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) Chromolyte Limited Ms Breda Pauline Hickey Care Home 65 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (34), of places Physical disability (13) Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The service is registered to provide a maximum of 65 places in total Service users to include up to 34 OP and up to 13 PD and up to 18 DE(E) The service should at all times employ a suitably qualified and experienced manager who is registered with the CSCI 8th December 2004 Date of last inspection Brief Description of the Service: Manchester House is registered to provide nursing care for up to 48 elderly people and 15 younger adults with physical disability. The older persons care includes a registered unit for people with dementia. Chromolyte Ltd owns the Home privately and the Responsible Individual is Mr A. M. Zachariah. The Registered Manager is Breda Hickey RGN. Manchester House is large converted building situated close to Hesketh Park and within easy reach of Southport town centre. The accommodation consists of the Bedford Unit which is an elderly dementia care unit situated on the ground floor on one level. It includes its own separate day space and access to two out door areas. The remainder of the home is for the general elderly and younger physically disabled service users [Albert and Victoria units] and is over 2 floors with level access via lifts. There are 3 large day space areas for this group. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted over a period of 2 full days. All 3 units were visited. All day and recreation areas were seen and many but not all of the residents bedrooms. Care records and other records kept in the home such as health and safety records and staff files were also viewed. In total 11 residents in the home were spoken to along with 2 relatives, 9 members of staff and the Manager. 7 of the residents also completed comment cards and comments have been reflected in the overall report. The views of a visiting GP as well as 2 health and social care professionals were also sought. 14 of the 20 Core standards were covered on the inspection. There were many positive aspects to the inspection and the management were responsive and open to comments made. The residents in the home generally felt that they were cared for and that staff were responsive to their needs. There are some major areas of management that still need attention and have been the focus of previous inspection reports. It was disappointing that these had not been addressed. These include the cleanliness and running of the laundry and the recruitment checks on new staff to ensure that they are fit to work in the home. What the service does well: The home provides some useful information in the form of the ‘Service Users Guide’ and this is available in the entrance to the home and also displayed in other areas. This helps ensue that prospective residents can make an informed choice about where to live. Each resident is assessed prior to being admitted so that the home is clearer about meeting any particular care needs. Once admitted there are further assessments carried out and these include areas of good practice such as medication administration, manual handling, pressure sore risk and nutrition. From the assessments a care plan is devised. These are very clear and well written and describe care in good detail including social care and psychological Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 6 needs. For example preferences for care in case of death. They follow a model of care which focuses on activities of daily living that residents need assistance with. The home has developed good procedures around the care of the dying and staff have attended specialist training courses. The home liaises very well with health care professionals from the community and manages some complicated care needs effectively. Staff take time to encourage self determination for residents and balance this well against any assessed risks. There was an example of this with one resident who was being put at risk by input from a family member. This was managed sensitively with input from advocates who were able to speak for he resident and the relative concerned. There is a busy but relaxed atmosphere in the home and staff were observed to be very supportative and to socialise with he residents. Residents commented on the general attitude of the staff: ‘ It’s a relaxed atmosphere and you can have your privacy although staff are always available’. ‘Staff ask about how you feel – they don’t dictate’. ‘Staff are very willing and cheerful’ ‘ Staff are very approachable and helpful’ The general environment is homely and comfortable. Bedrooms are well personalised and residents spoken to were pleased with the accommodation which is maintained in a clean and hygienic state. What has improved since the last inspection? The manager has worked at meeting some of the requirements and recommendations from the last inspection. A copy of the inspection report by CSCI is now available in the home to accompany the written information Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 7 available. Residents are now assessed regarding their ability to self medicate and a policy has been devised around this. There has been some progress made around care planning in that there is more consistency and staff try to include relatives and residents in the care planning process. There are activities being organised in the home and a programme is displayed. This involves some of the residents who are actively involved in this process. The manager has organised training around awareness of abuse of residents and how this can be reported. Policies and procedures are available. The complaints policy and procedure in the home has been revised and this was again updated during the inspection following some good practice guidelines. The deputy manager and the kitchen assistant have been on training for Health and safety management and have updated many of the homes policies and procedures around risk assessment. What they could do better: There are some requirements and recommendations in the report for the upgrading of some resident areas in the home. These include an extractor fan to be fitted in the smocking area so that residents can use this area with more comfort and less of a health risk due to high levels of cigarette smock. The bathroom on the first floor needs to be made usable by repairing the bath hoist. In conversation with the manager it is apparent that there is a need for a shower facility and there should be some consideration with respect perhaps replacing the bath with a suitable shower facility. The toilet on the Bedford unit is very cold and needs some form of heating installed so that the elderly frail residents can use his facility in comfort. There was some discussion with residents on the inspection around the provision and organisation of holidays for the younger adults. Such a short holiday had been planned for some residents but had been cancelled due to lack of support from the Provider. Residents also stated that a major barrier to engaging in community activity outside the home was the lack of affordable transport. The Provider in consultation with the Management and residents should look at this area of care so that an agreed strategy can be reached and a policy regarding the provision of such ventures can be drawn up. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 8 The environmental health inspection of the kitchens revealed some outstanding requirements outstanding from previous inspections. The management must ensure that they work at meeting all requirements from statutory inspection bodies. The laundry provision in the home must be reviewed. An immediate requirement was issued with respect to the ensuring that the laundry is made serviceable in the short term as machines were out of service and had been so for over a week causing a building up of laundry in this area which presented as an infection control and fire risk. In the longer term there must be an upgrading of the laundry as itemised in this report so that the area can be better kept in a clean state with some back up machines in case of future breakdown. The issue of the laundry has now featured in the last few inspection reports. There is generally good management of most areas of Health and Safety in the home. The manager still needs to assess any risk in the home regarding legionella and ensure any action that may be needed. 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. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, There is written information on the home available for new and prospective residents and this is a useful guide so that residents can make an informed choice about were to live. The assessments carried out by the home following admission are good and help ensure that the home can meet the needs of residents admitted. EVIDENCE: The home has developed a Statement of Purpose and a ‘Service User Guide’, which give information to prospective and existing residents on the home. The management have acted on the previous requirement for a copy of the last Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 11 CSCI inspection report to be made available and copies of these were seen in the entrance hallway and also in other areas of the home. The administrator is responsible for ensuring that all new residents are issued with a contract and some of these were viewed. All residents admitted on the nursing units undergo a series of nursing assessments prior to and once admitted and those seen [5 files in total] were detailed and covered all the areas of need. They are based on a model whereby residents abilities to carry out daily activities of living are assessed. These assessments are also backed up by social worker or health assessments were necessary. The lead nurse on the Bedford unit in particular insists on health assessments from the Community Mental health Team prior to any admissions. It was also observed that relatives are asked for their input into the assessments. It would be usefull for relatives and residents to sign the assessments, as this would evidence good practice. Other assessments carried out include manual handling, nutrition and risk assessments including risk of pressure sores. Records also include a social profile. From these assessments a care plan is devised. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 [OP] 6,9, 19,18,20, 21. [YA] The care planning on all of the units is well devised and includes some input from the residents or representatives so that care needs are addressed appropriately. Liaison with health care support services is good throughout the home so that health care needs are fully met. The management of medicines is satisfactory so that residents are protected by safe practise. Residents in the home reported good staff / resident interactions so that issues of privacy and dignity for residents are maintained. EVIDENCE: Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 13 There has been some progress from the previous inspection in terms of the care planning process particularly on the Bedford unit. All care plans seen on all units were well written and clear they are very personalised and include all aspects of care including social and psychological aspects including any expressed needs around dying and death. Some of the residents reviewed are highly dependant and the care plans identify input from health and social care professionals outside the home. For example one resident had needs requiring specialist input from the continence advisory nurse. This professional commented that the home is always quick to liaise and there is a good ongoing professional relationship. Another resident on the Bedford unit had developed complex behavioural difficulties and was refusing medication. This had been identified on the care plan and then referenced through a risk assessment and input from the Community Mental Health team had been requested. A visit by a consultant psychiatrist had resolved the issues. A resident had recently died and the issues surrounding the death had been managed very sensitively. One resident interviewed who had suffered particularly from the bereavement was quick to praise the support that had been given by the staff in the home, especially the senior staff and manager. There are good policies and procedures around the care of the dying and two of the senior staff have completed specialist courses in this field. Although the staff are trying to involve residents in the care planning process [by placing care plans in some bedrooms for example] of the residents and relatives interviewed there were none who felt that they had had enough input and some who said they had not seen their care plan. The home has a good supply of disability aids and equipment including wheelchairs, walking aids and specialised mattresses for pressure relief. Since the previous inspection the home has developed some assessments around resident’s self-medication and 2 younger adults have been tried in terms of managing their own medicines. The storage and administration systems on the Bedford Unit were reviewed and were satisfactory. There are routine audits by the supplying pharmacist, which cover storage, ordering and administration of medicines. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 14 Residents spoken to stated that the home staff are very supportative and respect the right of self-determination. Care notes evidenced risk assessments for some service users as a way of focusing on issues of self determination balanced against the homes duty of care. This was particularly evident when dealing with one resident who had identified needs involving risk factors associated with input from a family member. This was managed with liaison with other care professionals and advocates so that a resolution that continued to involve the family member was reached. Residents interviewed all stated that the staff were very supportative and managed care sensitively. Comments included: ‘ It’s a relaxed atmosphere and you can have your privacy although staff are always available’. ‘Staff ask about how you feel – they don’t dictate’. ‘Staff are very willing and cheerful’ ‘ staff are very approachable and helpful’ Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 [OP] and 13,14, [YA] There has been an improvement from the previous inspection in that a planned, though flexible, approach to the organisation of social activities for some residents in the home encourages personal development and socialisation. Social and personal development programmes for the younger adult group also need to include the provision of a planned annual holiday so that quality of life for residents can be improved. Provision of more readily available and affordable transport needs to be developed by the Provider so that the younger adult group can more easily access the local community facilities and feel part of the community. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 16 EVIDENCE: The home has developed a regular activities programme over the last year. There is an activities coordinator employed and there is a small budget of £50 per month for the provision of some activities. The activities programme is advertised and it includes some activities run by residents themselves. Residents spoken to are clearly interested in developing the programme further. Currently there are regular visits to luncheon clubs and coffee mornings for some residents. There is a relaxed atmosphere in the home and both residents and relatives commented on this. Staff were seen to be regularly interacting with residents and have the skills necessary to create a supportative environment. Not all residents are catered for however and more could be planned in this area. The residents with dementia could have more planned input and the comments from the previous inspection report largely still stand although better continuity of staff on this unit has meant more regular social interaction. Some of the residents attend activities organised for the rest of the home. There was some discussion around the possibility of making the second day area on the dementia care unit the main activities area and this could ensure better access for those on the dementia unit to activities. Some younger adults were interviewed. They related that a holiday trip had been organised last summer but had had to be cancelled due to lack of support from the homeowner who had provided no funding or staff for this. Standard 14.4 of the National Minimum Standards states that younger adult residents should ‘as part of the basic contract price the option of a minimum 7 day annual holiday outside the home which they help choose and plan’. Whilst this standard is not appropriate for all residents there should be some agreement reached by the provider in liaison with residents and staff towards meeting some of the cost of this sort of activity. Like wise the main barrier to younger adults accessing the community and becoming more socially included is the lack of transport. The current system of hiring taxis and local private transport provision is very expensive for the physically disabled residents and some do not therefore access the community outside the home in any regular or meaningful way. Clearly there is a need here for the provider to evaluate with staff and residents the sort of financial support needed to assist in meeting both of these standards. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) 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 [OP] and 22,23 [YA] The home has a complaints procedure and residents and relatives feel that their concerns are listed to. Residents are protected from abuse by the homes policies, procedures and staff training so that they feel secure and cared for. EVIDENCE: The home has a complaints procedure and this is displayed in the home and is also included in the resident’s information. Relatives and residents interviewed stated that they were aware of the complaints process and would feel confident about approaching staff and the management of the home. Complaints are recorded and there have been 5 complaints since the last inspection that have been investigated by the manager and outcomes reported to the complainants. There was some discussion as to how complaints are recorded and issues of confidentiality. Changes were made to the policy and the method of recording during the inspection. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 18 There have been no complaints to CSCI about the service since the last inspection [December 2004]. There are policies covering the mistreatment and abuse of vulnerable people and local multi agency procedures are available. The manager has organised training for staff on awareness of abuse and nearly all staff have completed this. Staff interviewed were able to discuss ‘mistreatment’ and had a good understanding of the principals of care to ensure that good care standards are maintained. An example of this was the way the home dealt with a sensitive issue concerning the care of a resident who was being put at risk by a family member. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 19 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) 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, 21, 25,26 [OP] 24, 27,30 [YA] The general environment for residents is maintained satisfactorily although specific areas identified need to be addressed so that standards are consistent so that residents can use all facilities. The attention to compliance with all aspects of environmental health needs to be addressed by the provider with reference to the standards in the laundry and compliance with environmental health requirements in the kitchen so that residents are living in a safe home. EVIDENCE: Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 20 The home is situated in a convenient location fairy close to Southport Town Centre and in close proximity to Hesketh Park. The internal environment is generally bright and airy. Bedrooms were observed to be well-presented and displaying evidence of individual personalisation. The home has the advantage of rooms that are generally more than the required minimum standard in terms of size, which assists with the mobilisation of equipment etc. Externally the garden to the front of the building is well maintained and there are accessible outdoor areas, which are enclosed and safe for service users on the Bedford unit. The inspector was able to observe a good range of disability equipment and the services of a physiotherapist are a regular feature in the Home. The designated smoking lounge situated on the ground floor has no ventilation [apart from windows which are impractical to open in cold weather]. On the inspection it was unpleasant to breath in this area and residents reported that ‘it is often worse than this’. The provision of adequate ventilation is therefore required. The home now has a maintenance person on hand on a daily basis which has improved the overall management of the maintenance in the home and ensured that jobs are carried out quickly. There were some minor maintenance issues identified on the Bedford Unit [locks on toilet doors to be repaired] and the team leader advised that this would be addressed. One toilet identified on the Bedford unit was very cold and would be unpleasant for residents to use. Some form of heating should be considered. The bathroom on the first floor is out of use. Residents in this area stated that they had to go downstairs for a bath. The bathroom needs to be made available for residents. In discussion with the manager it became apparent that a shower facility would be much more appropriate and better used. Residents interviewed agreed with this. The general environment was found to be clean and hygienic with no offensive odours. The laundry remains in poor condition. On this visit all but one of the washing machines and all of the dryers were not working and staff were having to take laundry off site to dry. There was a large backlog of dirty washing piled in the laundry area causing both fire and infection risk. During the course of the visit some arrangements were made to clear this so that the fire exit could be accessed. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 21 The requirements made in previous reports around the upgrading of the laundry so that it can be more easily cleaned have not been fully actioned. The floor was again cracked and flaking and the wall behind the machines are porous and cannot be cleaned. There were also old disused washing machines, which should be removed to create more space. An immediate requirement was issued and a further visit was conducted on 25.11.05 when the laundry was being made servicible. The environmental health officer was visiting the kitchen at the same time as the CSCI inspection. When spoken to the officer commented that there was still outstanding work to be completed in the kitchen regarding meeting hygiene standards and there would be a revisit of the kitchen at a later date. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 22 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 [OP] 33,34 [YA] There are appropriately trained and experienced nurses and care staff employed so that residents feel supported and that their needs are understood and met. The recruitment processes in the home are generally not robust enough to ensure sufficient protection for residents and need to be more consistent. EVIDENCE: The Albert and Victoria Unit had 43 residents at the time of the inspection. Most of these were highly dependant. The units were staffed with 2 trained nurses and 11 care staff. These numbers fluctuated at times in the day and wee listed on the duty rota. The Bedford Unit had 17 residents and was staffed by 1nurse and 3 carers. I resident was on 1:1 observations and extra agency staff was available to cover this. Both residents and staff spoken to were satisfied with the amount and he quality of staff on duty in the home and felt that needs were met. Comments Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 23 were; ‘ the staff always come quickly when I call them [call system] and ‘staff are always helpful and friendly’. The manager is supernummery to these figures. Over the past few inspections of the home the manager has built a fairly stable staffing establishment, especially trained staff who now form a solid and experienced team. Domestic and kitchen staff are also employed and the home also has a staff member who organises activities in the home. Staff files were seen and the recruitment of staff was discussed. 4 staff files were seen and varied in the amount of detail recorded. For example 1 staff member had been transferred from within the group [of homes] and had very little information on file. The staff file should accompany staff in this instance so that the manager can satisfy herself of staff fitness. There are a lot of staff from overseas employed and the details on file were regarding immigration status were not always apparent. The company does have a central office at a different location and the administrator stated that records could be sometimes split between sites. If the company policy is for staff files to be maintained at that location then the homes policy needs to be consistent and clarified accordingly. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) 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, 38 [OP] 37, 42 [YA] The registered manager is qualified and competent and residents benefit from well managed care. The health and safety management is now effective and the welfare of residents is promoted and protected. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 25 EVIDENCE: Breda Hickey is the Registered manager of Manchester house. She has completed the Registered Managers Award. She is a trained nurse (RGN) and has completed further training in Teaching and Palliative care. Breda has had previous management experience in the NHS. Those residents and staff interviewed were very supportative of h manager and described her as having a ‘hands on’ approach meaning that she is able to balance management responsibilities with providing an effective lead in terms of clinical input to the nursing care. Since he last inspection the deputy manage and the kitchen supervisor have completed training in Health and Safety and have devised policies and procedures for the home. Risk assessments are carried out and designated staff have responsibilities in different areas of the home regarding these with the manager coordinating. The requirement from the previous inspection regarding the filing of accident records has now been actioned. Maintenance certificates were available; for example gas and fire [electrical cert just being renewed]. There was some discussion around the need to ensure that the legionella risk in the home is assessed and any necessary action followed. This with respect to the size of the home in particular. Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 26 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 3 2 3 3 3 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 X 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 2 22 X 23 X 24 X 25 2 26 1 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 X 34 X 35 X 36 3 37 X 38 3 Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 27 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 Standard YA24 OP21 OP25 Regulation 23 23 23(2)p Requirement The lounge designated for smoking must be fitted with an extractor. The bathroom on the first floor must be made functional for residents use. The toilet identified on the Bedford unit must be adequately heated so that residents can use it comfortably. The homes laundry must be upgraded to ensure ease of cleaning. The floor needs a suitable non-porous finish. The walls behind the washing machines need to have a readily cleanable surface. There must be adequate provision made for the eventuality of machines breaking down and awaiting repair. All staff including overseas staff must have up-to-date staff records that include evidence of all recruitment checks and references. Files must be maintained as in schedule 2 of the Care Home regulations. [Last requirement date of 21.1.05 not met] DS0000017249.V266598.R01.S.doc Timescale for action 01/03/06 01/03/06 01/01/06 3 OP26 13(3) 16(2) 01/03/06 5 OP29 19 05/01/06 Manchester House Version 5.0 Page 28 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 OP7 YA13 Good Practice Recommendations Continue with the emphasis on engaging residents and relatives in the care planning process as discussed. The provision of a homes mini bus would greatly improve the access for disabled residents and therefore improve their quality of life. Similarly the provider should negotiate in consultation with both residents and staff the provision of some funding towards the cost of holidays for those residents who express a need. The manager should consider the ongoing developments for activities, particularly for residents on the Bedford unit as discussed on the inspection The provider should ensure that the requirements of the environmental health report are actioned appropriately. The locks on the toilet doors are maintained satisfactorily [Bedford Unit]. A shower room would be recommended to replace the bath on the first floor. The management of legionella should be thoroughly assessed and any action required should be carried out. 3 4 5 6 7 OP12 OP19 OP19 OP21 OP38 Manchester House DS0000017249.V266598.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 House DS0000017249.V266598.R01.S.doc Version 5.0 Page 30 - 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. 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