Inspection on 19/02/08 for Manchester House

This inspection was carried out on 19th February 2008.

CSCI found this care home to be providing an Good 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 House 03/11/06

Manchester House 16/11/05

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 Mike Perry Key Unannounced Inspection 19th February 2008 10:00 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.V359992.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 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.V359992.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manchester House Address 83 Albert Road Southport Merseyside PR9 9LN 01704 534920 01704 501053 elaine.whitehead@btinternet.com 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.V359992.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 34 OP and up to 13 PD and up to 18 DE(E) The service is registered to provide a maximum of 65 places in total The service should at all times employ a suitably qualified and experienced manager who is registered with the CSCI 3rd Nov 2006 [key inspection] Date of last inspection Brief Description of the Service: Manchester House is registered to provide nursing care for up to 48 elderly people and 13 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. The current fees are £365 to £569 Manchester House DS0000017249.V359992.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 2 stars. This means the people who use this service experience good quality outcomes. The inspection was unannounced and was conducted over a period of two days. All three 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. Residents in the home were spoken to along with relatives and members of staff including the manager. One of the residents was approached prior to the inspection visit in order to assist wit the ‘link resident’ scheme. This is where a resident assists with giving out and collecting in survey forms so that the inspector can access more information and views about life in the home. Some of these were filled in by residents and returned. Similarly, the views of relatives were also accessed by surveys and comments are included in the report. A social care professional was also spoken to. 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. What the service does well: All care plans seen on all units were well written and clear they are very personalised and include all aspects of care. Staff also try and include the relatives of elderly residents where possible. Those younger adults interviewed stated that they had seen [or had got] copies of the care plan and that staff discussed care with them. Some of the residents reviewed are highly dependant and the care plans identify input from health and social care professionals outside the home. a social worker commented: ‘I’m happy with the care in the home. The staff manage x very well and liaise effectively with myself and other members of the Community Mental Health Team. This person was admitted for social reasons and the staff understand the care needs well’. Likewise the resident said: Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 6 ‘It’s a good home. The staff are like family. They are nice and kind. I like it here and I can see my husband every day. We’re both looked after well’. Residents and relatives interviewed all stated that the staff were very supportative and managed care sensitively. One relative on the dementia care [Bedford] unit was spoken with and commented: ‘Its wonderful here. I had a good feeling about the home from the word go. It’s alive, and the kindness of the staff is incredible. My relative is in mental turmoil and they try everything to help. They will spend 45 minutes just helping to feed. Its excellent’. The home has two full time activities co coordinators and the provision and organisation for activities for residents has vastly improved over the past two inspections. Residents spoke warmly of the trips out and also some of the daily activities inside the home. There is a relaxed atmosphere in the home and both residents and relatives commented on this. One relative spoke about the attention paid to residents: ‘They try and divert x. the activities person has a memory box and goes through this with him. He also gets out in the garden sometimes, as he likes that. I can visit any time. The staff sing to him there’s always something going on’. Another younger adult spoke about a holiday last year with his girlfriend and how this had been arranged with support from staff and how the relationship generally is supported. Another resident is supported on a daily basis with visits to her husband who is also resident in the home. At the time of the inspection one resident was involved in flower arranging and was clearly benefiting from the attention. There is an activities room which has access to a safe garden area although activities are carried out in all areas of the home. The home has a pleasant dining room for general elderly and younger adults and meals were observed to be social occasions. Residents explained how there was a choice at meal times and that the quality of the food was very good. On the Bedford unit the dining room is part of the main day area. Staff were observed to be assisting residents where necessary and the pace of the meal time was relaxed with good attention being paid to those residents who need assistance with diet and feeding. What has improved since the last inspection? There has been progress in terms of meeting recommendations from the previous key inspection. These include: Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 7 • The recommendations in the report on the water system and management of legionella have been actioned and the management of this area ensures safety of residents. All assessments of residents needs before admission are of a good standard and help ensure that the admission is suitable and that care needs can be met. There has been some improvements to the internal environment of the home including decoration of some areas and the instillation of a shower facility. The information in staff files has improved in that staff are checked routinely for suitability for employment in the home. • • • What they could do better: On reading the information guide for the home [Service User Guide] it was evident that there was insufficient information covering the provider, manager and staff and the guide still needs updating. This was evident on the previous inspection and therefore remains outstanding. One resident reviewed as part of the inspection has been admitted to the home 18 months ago and has primary care needs around mental health issues including some elements of risk in terms of behaviour. At the time of the admission an application to the registration authorities was needed and this was not made. This compromises the integrity of the homes registration. An application is now needed and must be completed. Care planning is generally good but could be further improved by the recording of more in-depth evaluations or reviews. These are a record of the discussion around the progress made by residents set against any aims and objectives that may be in the plan of care. The discussion should include the resident or representative. There are some recommendations in the report around recording of medication administration. In particular there should be two staff signatures for any handwritten note of medication prescribed by the GP so that the risk of error is reduced. The staff files are now more ordered and routine employment checks are carried out. The inspector did point out some discrepancies and the home should follow these up. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 8 The provider should complete a report of his visits to the home [under regulation 26 of the Care Home Regulations] and ensure that the manger gets feedback so that any issues can be further addressed. Financial records were seen for residents and it was noted that there is not two signatures for some entries. This should be good practice to ensure correct records are maintained. 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 House DS0000017249.V359992.R01.S.doc Version 5.2 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.V359992.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are assessed prior to admission so that their care needs can be met and the placement is suitable although in one instance the resident has been admitted ‘out of category’ for the homes registration and this must be addressed through a separate application to the Commission so that the integrity of the homes registration is maintained. 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 Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 11 guide was seen in the entrance hallway and at various points around the home. The copies were generally in poor condition and the copy of the CSCI inspection report contained in the guide was poorly referenced so it was not clear what the report was [the last report was available separately]. Residents interviewed were generally satisfied that they had received enough information about the home but most could not recall or make reference to the service user guide. For example one relative interviewed had recently been involved in the admission of her elderly relative but could not recall seeing any written information. The relative was pleased with the way staff had spent time however and felt that her questions had been answered and had generally been impressed with the ‘professionalism of the staff’. On reading the guide it was evident that there was insufficient information covering the provider, manager and staff and the guide still needs updating. This was evident on the previous inspection and therefore remains outstanding. Suggestions for improvement include updating the guide to include provider and staff details, referencing the existence of the latest CSCI inspection report and having more copies of these available throughout the home. All residents admitted on the units undergo a series of nursing assessments prior to and once admitted and those seen were consistent in quality. Those seen 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. One resident reviewed as part of the inspection has been admitted to the home 18 months ago and has primary care needs around mental health issues including some elements of risk in terms of behaviour. On speaking to the social worker it is evident that the resident has settled in the home but the need at the time of the admission was such that an application to the registration authorities was needed as part of the admission and this was not made. This compromises the integrity of the homes registration. An application is now needed. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 12 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. The fact that all residents are now assessed is an improvement from the previous inspection. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and personal care needs are consistently met so that residents are well cared for. EVIDENCE: 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. Staff also try Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 14 and include the relatives of elderly residents where possible. Those younger adults interviewed stated that they had seen [or had got] copies of the care plan and that staff discussed care with them although in terms of formal reviews or evaluations this was not as consistent. There was some discussion with the manager of the importance of going over the care plans with residents [or relatives as appropriate] at the time of evaluations of the care plans and recording this. The recorded evaluations are very brief and almost wholly consist of ‘no change’, although the manager pointed out that any new change would be written up on a short-term care plan. The evaluation should be a record of the discussion around any progress made set against the aims and objectives of the care plan and, as a matter of good practice would better inform the care planning process and provided a more accessible update as to progress made. Some of the residents reviewed are highly dependant and the care plans identify input from health and social care professionals outside the home. One resident had presented with particular difficulties around the management of risk behaviour and the home had liaised with psychiatric services to get appropriate advice and support. The social worker commented: ‘I’m happy with the care in the home. The staff manage x very well and liaise effectively with myself and other members of the Community Mental Health Team. This person was admitted for social reasons and the staff understand the care needs well’. Likewise the resident said: ‘It’s a good home. The staff are like family. They are nice and kind. I like it here and I can see my husband every day. We’re both looked after well’. A resident with communication and mobility needs was reviewed. The resident stated: ‘I get on with all of the staff. I get about with my walking stick. They show me my care plan sometimes and they sort out my personal care – they help me’. This residents care plan highlighted the need to communicate effectively and to give the resident time to speak. The care notes listed good liaison with health care professionals such as GP and stoma nurse. The home admits people with physical disability and has a good supply of disability aids and equipment including wheelchairs, walking aids and specialised mattresses for pressure relief. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 15 The home has developed some assessments around resident’s self-medication and although there are currently no residents self-medicating there is evidence that this has occurred in the past. The storage of medicines on the general care units was reviewed and is satisfactory. The drug administration records were also viewed and were clear and easy to follow and were up to date. One resident on a controlled medicine only had one signature recorded in the controlled drugs register and this was pointed out and corrected at the time of the inspection. Also one handwritten record of a medicine taken over the phone form a GP was not signed by the staff concerned. It is good practice for all such entries to be signed by two staff members so that the risk of inaccuracies is reduced. There are routine audits by the supplying pharmacist, which cover storage, ordering and administration of medicines. Records for other medicines reviewed were satisfactory. Resident’s interviewed stated that medicines are always given correctly and on time. The medicine round on the Bedford unit was observed and was managed well. 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 evident with one resident with mental health needs who has resented with some difficult to manage behaviour. There is a supporting care plan from the social worker, which advises and supports the homes care plan. Residents and relatives interviewed all stated that the staff were very supportative and managed care sensitively. One relative on the dementia care [Bedford] unit was spoken with and commented: ‘Its wonderful here. I had a good feeling about the home from the word go. It’s alive, and the kindness of the staff is incredible. My relative is in mental turmoil and they try everything to help. They will spend 45 minutes just helping to feed. Its excellent’. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards The quality in this outcome group is excellent. This judgement is made on the available evidence including the site visit. There is a planned, though flexible, approach to the organisation of social activities for residents in the home which encourages personal development and socialisation. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 17 EVIDENCE: The home has two full time activities co coordinators and the provision and organisation for activities for residents has vastly improved over the past two inspections. The staff responsible are enthusiastic and have organised regular social events as well as the daily activities. Residents spoke warmly of the trips out and also some of the daily activities inside the home. 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. The social life of the home continues to be developed. One relative spoke about the attention paid to residents: ‘They try and divert x. the activities person has a memory box and goes through this with him. He also gets out in the garden sometimes, as he likes that. I can visit any time. The staff sing to him there’s always something going on’. Another younger adult spoke about a holiday last year with his girlfriend and how this had been arranged with support from staff and how the relationship generally is supported. There are entries in the care notes and assessments also cover relationships. Entries indicate that the staff have a good understanding of resident needs in this area. Another resident is supported on a daily basis with visits to her husband who is also resident in the home. The activities organiser was spoken with and explained how there is now more one to one care with people on the dementia care unit and all residents receive some input on a regular basis. The notes maintained of the activities also evidenced this. At the time of the inspection one resident was involved in flower arranging and was clearly benefiting from the attention. There is an activities room which has access to a safe garden area although activities are carried out in all areas of the home. One resident is encouraged with artwork and said she feels better because she is able to follow this activity. The work is displayed throughout the home. Activities are open to regular review and feedback from residents and relatives and continue to be developed along good practice guidelines. The activities display boards evidence recent activities arranged. The home has a pleasant dining room for general elderly and younger adults and meals were observed to be social occasions. Residents explained how Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 18 there was a choice at meal times and that the quality of the food was very good. Tables are set and residents were observed to be well supported. The main meal was a choice of three options and all were well received. On the Bedford unit the dining room is part of the main day area. Staff were observed to be assisting residents where necessary and the pace of the meal time was relaxed with good attention being paid to those residents who need assistance with diet and feeding. The staffing at the time was good so that care could be organised properly in a relaxed manner. It was observed that alternatives were offered and staff were continually encouraging and monitoring intake. Following the meal the staff record diet and fluid intake on ‘all care’ charts. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards The quality in this outcome group is good. This judgement is made on the available evidence including the site visit. 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. There was only one general complaint investigated during the last year and this concerned a missing wheelchair and a complaint by a relative. The manager investigated this and replied to the complainant within the time scales. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 20 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 all staff have completed this. There have been three referrals under the safeguarding procedures and, particularly in the latter two the management of the home have displayed a knowledge and willingness to refer and get any issues properly investigated. All of the residents spoken with feel very safe in the home and feel that staff will listen and act appropriately to any concerns. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards. The quality in this outcome group is good. This judgement is made on the available evidence including the site visit. The general environment for residents is maintained so that residents are living in a safe and comfortable home. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 22 EVIDENCE: 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 home has a maintenance person on hand on a daily basis, which ensures the maintenance in the home, and that jobs are carried out quickly. All of the requirements and recommendations from the last report have been actioned. There have been developments including the conversion of space on the Bedford unit to create an extra laundry facility and a shower facility for one of the units [another is planned]. There have also been some new furnishings purchased for the Bedford unit so that residents now have a choice of comfortable chairs. The general environment was found to be clean and hygienic and the comments received from residents were that this standard is maintained. Residents clearly enjoy the diversity of space in the home and felt comfortable in their surroundings. Following a site visit by the fire officer a number of recommendations have been made regarding fire doors in the home as well as the wiring up of the front door to the alarm system to meet safety standards. The manager is planning this work. The ‘smoking room’ situated on the ground floor has no extractor in place and this would be recommended. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are recruited and trained appropriately and are present in enough numbers so that care needs can be met on a consistent basis. EVIDENCE: The Albert and Victoria Unit had 46 residents at the time of the inspection. Most of these were highly dependant. The units were staffed with 2 trained nurses and 10 care staff. These numbers fluctuate at times in the day and were listed on the duty rota. The numbers were consistent over the two days of the inspection. The Bedford Unit had 17 residents and was staffed by 1 nurse and 4 carers. The nurse in charge confirmed that the usual staffing is 3 / 4 carers. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 24 Both residents and staff spoken to were satisfied with the amount and the quality of staff on duty in the home and felt that needs were met. The manager is supernummery to these figures. The turnover of staff, particularly nursing staff, has stabilised and the staff generally is consistent and experienced. Domestic and kitchen staff are also employed and the home also has two staff members who organises activities. Staff files were seen and the recruitment of staff was discussed. The records have improved and those inspected [four in total] had most of the required checks in place. The administrator explained that there had been difficulties with processing some records due to the homes loss of status with the Criminal records Bureau [CRB] but his has now been sorted out and applications can be made. On this inspection one record did not have a second reference and the administrator said she would correct this. Also one staff who worked in the kitchen still needed to have basic checks made. This person is directly supervised and does not come out of the kitchen into the rest of the home and so the need for a full ‘enhanced’ CRB check was discussed. The homes policy is for all staff to have enhanced checks however and this needs to be actioned. The administrator stated that checks made with reference to the Protection of Vulnerable Adult register [POVA], before the CRB is returned, are subsequently destroyed but it is recommended that these are kept on file as evidence that this check is carried out if the staff member commences work in the care home before the full CRB check is returned. The checklist that is signed of by the manager as an audit of staff files was not always completed and it is strongly recommended that this check be made consistently as the manager is ultimately accountable for staff and their fitness to work in the home. Staff spoken with were clearly enjoying their work in the home and felt that the care standards were good and that they could contribute towards any improvements and that their views were listened to. One staff commented; ‘Staff meetings are variable but we do have them and we can get our ideas across. We have supervision. Breda [manager] does mine – fairly regular. She is very accessible. I feel it’s a good home and well run. Some things have improved a lot such as the activities, which are now very good. The food is also good and has improved. I have done quite a bit of training such as moving and handling assessors training and I now train other staff. I’ve also done food hygiene and diabetes and am doing venapuncture training [taking of blood] soon’. Training files were seen for some of the staff and other staff interviews confirmed that there is ongoing training in the home. A high percentage of the care staff have completed NVQ training and many of these are at level 3. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 25 Some of the nursing staff have additional specialist training. For example the nurse in charge on the Bedford unit has completed training in dementia care and staff on the general care units have palliative care training. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has ongoing management systems in place so that resident’s views are audited and the home is run in their best interests. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 27 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 the 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. Residents and visitors knew who she was and found her approachable. There are various quality assurance processes including the annual external audit [PQR], which contains elements that aim to enlist resident’s views and satisfaction regarding the running of the home. Internally there are various residents meetings. One resident said: ‘I feel the home is very well run. The staff and managers try and include the residents where they can. We have meetings and are kept informed.’ The manager completes a quality audit known as Regulation 26 audits on a regular basis on behalf of the registered owner who is also a regular visitor to the home. This was discussed as the requirement is for the registered provider to complete these. Residents finances are managed through the administrator in the home. Those residents interviewed were happy that they receive their benefits and that they could access any funds fairy quickly. Most of the residents manage their own affairs to some degree. Records were seen for some residents and it was noted that there is not two signatures for some entries and this should be good practice to ensure correct records are maintained. Risk assessments, for health and safety purposes, are carried out and designated staff have responsibilities in different areas of the home regarding these with the manager coordinating. All records seen were up to date and the recommendations on the last visit around the safe management of the water system have been actioned. Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 28 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 2 X 3 3 4 X 5 X 6 N/a 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 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 3 Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 29 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 YA3 Regulation CSA Sec 24 Requirement The registered person has failed to comply with the conditions of registration of the home by admitting a person ‘out of category’ with respect to care needs. The registered person must now apply to vary the conditions of registration to accommodate the resident. Timescale for action 01/04/08 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 Refer to Standard OP1 Good Practice Recommendations The service user guide for the home should be updated and made available with reference to the comments in this report as well as schedule 1 of the care homes regulations. The evaluations carried out periodically on the residents care plans should be more detailed. These are a record of the discussion around the progress made by residents set against the aims and objectives of the care plan. 2 OP7 Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 30 The evaluation of the care plan should include periodic input by the resident and/or relative. 3 OP9 Any handwritten entry on the medication administration record [MAR] should be signed by 2 staff members to reduce the risk of error. The recommendations of the recent fire officer’s inspection should be addressed. An extractor fan is recommended for the smoking lounge. 5 OP29 The staff identified that requires a second written reference should have this addressed. The staff working in the kitchen should have routine checks for CRB and POVA carried out. Staff files should have a start date recorded on the ‘check list’ and the manager once satisfied that records are correct should sign this of. It is recommended that original POVA checks are kept on file as evidence that this check is carried out if the staff member commences work in the care home before the full CRB check is returned. 6 OP33 7 OP35 Financial records were seen for some residents and it was noted that there is not two signatures for some entries. This should be good practice to ensure correct records are maintained. The provider should complete the regulation 26 reports and give appropriate feedback to the manager. 4 OP19 Manchester House DS0000017249.V359992.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 House DS0000017249.V359992.R01.S.doc Version 5.2 Page 32 - 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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