Inspection on 03/11/06 for Manchester House

This inspection was carried out on 3rd November 2006.

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 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 Mr Mike Perry Unannounced Inspection 3rd November 2006 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.V311040.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.V311040.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 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.V311040.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 16th November 2005 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 £273.50 to £495 Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 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 3 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 14 residents in the home were spoken to along with 2 relatives, 12 members of staff and the Manager. 7 of the residents also completed comment cards and comments have been reflected in the overall report. A two-hour observational inspection was carried out in the dementia unit. This involved watching how residents and staff interact with each other. Details from this observation are included in the main part of the inspection report. This tool assists the inspectors when people have communication difficulties. It has been used as well as talking directly to residents and asking their opinions on the home. 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. For the third inspection running the recruitment policy of the home is failing to ensure that all staff have the necessary pre employment checks to ensure fitness to work with vulnerable people and the Manager must now address this with some urgency. What the service does well: All residents admitted on the units undergo a series of nursing assessments prior to and once admitted. Some 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. 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.V311040.R01.S.doc Version 5.2 Page 6 and include the relatives of elderly residents where possible. Those younger adults interviewed stated hat they had seen [or had got] copies of the care plan and that staff discussed care with them. The home has a good supply of disability aids and equipment including wheelchairs, walking aids and specialised mattresses for pressure relief. 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 home does admit a diverse range of residents and are able to meet needs individually. For example some residents have mild learning disabilities [together with their physical disability] and the home is liaising with social services regarding appropriate provision of service. One resident has expressed a wish to attend college and this is being looked into. Residents and relatives interviewed all stated that the staff were very supportative and managed care sensitively. Some of the comments recorded were: ‘The staff are very good. They treat me like an adult and are easy to talk to’ ‘The nurses are very helpful and support me. They discuss the care with me’ ‘Staff are like a family – I wouldn’t swap them for the world’. Meals were observed to be social occasions. One resident 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. 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 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. The internal environment is generally bright and airy. Bedrooms were observed to be well-presented and displaying evidence of individual personalisation. 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 general environment was found to be clean and hygienic and the comments received from residents were that this standard is maintained. Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 Page 7 Residents clearly enjoy the diversity of space in the home and felt comfortable in their surroundings. 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. Comments were positive; ‘ marvellous nursing when I was ill’, ‘staff are wonderful – this is a happy and safe haven’. The turnover of staff, particularly nursing staff, has stabilised and the staff generally are consistent and experienced. Training files were seen for some of the staff and 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. 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. 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. What has improved since the last inspection? What they could do better: 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 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. There was some discussion with the manager with respect to how the guide could be updated and better promoted. Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 Page 8 The administrator is responsible for ensuring that all new residents are issued with a contract. Some of the more recent admissions to the home do not have contracts. The drug administration records were also viewed and contained a number of discrepancies. Some controlled drugs were not recorded appropriately on receipt and some records did not give an accurate account of whether the medicine had been administered. For example one resident on lactulose [medicine for constipation] whose administration record was incomplete with some administrations not signed. The manager has introduced a system of charts in bedrooms so that staff can sign that they have administered the medicine but some of these were not being filled in so that a clear record of when creams and lotions are applied and by whom was not available. Some of the recommendations on the last inspection report have not been actioned. These were around the provision of some sort of annual holiday away from the home for some of the younger adult residents. There were some minor issues concerning the maintenance of the home that were discussed and are listed in the report. This is the third consecutive inspection that staff records have been incomplete and the required checks that need to be completed with respect to references and police clearance have not been made prior to commencing employment. Currently one administrator is covering 2 homes in the group and the provider and manager may need to review workload given the ongoing problems. The home has commissioned an inspection and subsequent report on the water system in the home and there are some recommendations following this. There was discussion also with the owner and these will be followed up. 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.V311040.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.V311040.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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2,3. [OP] The quality in this outcome group is adequate. This judgement is made on the available evidence including the site visit. There is written information on the home available for new and prospective residents and this is generally a useful guide so that residents can make an informed choice about were to live. It does however need updating promoting with reference to comments in the report so that the guide is more comprehensive. All residents do not currently have terms and conditions of residency or standard contracts on admission to the home. The assessments carried out by the home prior to and following admission help ensure that the home can meet the needs of residents admitted. Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 Page 11 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 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. 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. On reading the guide it was evident that there was insufficient information covering the provider, manager and staff. There was some discussion with the manager with respect to how the guide could be updated and better promoted. Suggestions 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. The administrator is responsible for ensuring that all new residents are issued with a contract. Most residents do have a contract but some of the more recent do not. All residents admitted on the units undergo a series of nursing assessments prior to and once admitted and those seen were inconsistent in quality. Some 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. Some [2] of the assessments seen were not on standard forms and were also not signed or dated however. 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.V311040.R01.S.doc Version 5.2 Page 12 Manchester House DS0000017249.V311040.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 to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. The quality in this outcome group is good. This judgement is made on the available evidence including the site visit. 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. Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 Page 14 The management of medicines is inconsistent and recording of administration and the receiving of medicines need to be addressed 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: 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 and include the relatives of elderly residents where possible. Those younger adults interviewed stated hat 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. One resident had presented with particular difficulties around the management of personal care and the unit [Bedford unit] had liaised with psychiatric services to get appropriate advice and support. A resident with communication and mobility needs was reviewed. The relative stated that the nursing care had been excellent and staff had been very good at liaising with support services to provide necessary equipment. The home has a good supply of disability aids and equipment including wheelchairs, walking aids and specialised mattresses for pressure relief. 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 of medicines on the general care units was reviewed and is satisfactory. The drug administration records were also viewed and contained a number of discrepancies. One resident is on a controlled drug [Methadone] and although new supplies were entered on the Controlled Drug register they were not entered on the administration records [MAR sheets]. Again two administrations of the drug were entered in the CD register but had been not recorded on the MAR sheet as given. Another resident on Fentinol patches [drug for pain relief] every 3 days had blank recordings on one day of administration so that it was not possible to tell from the records whether the drug had been given. The receiving of new Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 Page 15 supplies was also not entered on the MAR sheet [record was in the CD register]. There were some other omissions such as one resident on lactulose [medicine for constipation] whose administration record was incomplete with some administrations not signed. The administration of creams and lotions was discussed. The manager has introduced a system of charts in bedrooms so that staff can sign that they have administered the medicine but some of these were not being filled in so that a clear record of when creams and lotions are applied and by whom was not available. 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. 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 very evident with the one resident who is self medicating. This had been managed appropriately with reference to good risk assessments and liaison with other professionals. The home does admit a diverse range of residents and are able to meet needs individually. Some residents have mild learning disabilities [together with their physical disability] and the home is liaising with socials services regarding appropriate provision of service. One resident has expressed a wish to attend college and this is being looked into. Residents and relatives interviewed all stated that the staff were very supportative and managed care sensitively. Some of the comments recorded were: ‘The staff are very good. They treat me like an adult and are easy to talk to’ ‘The nurses are very helpful and support me. They discuss the care with me’ ‘Staff are like a family – I wouldn’t swap them for the world’. Manchester House DS0000017249.V311040.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. The quality in this outcome group is good. This judgement is made on the available evidence including the site visit. There has been an improvement from the previous inspection in that a planned, though flexible, approach to the organisation of social activities for residents in the home encourages personal development and socialisation. EVIDENCE: Some of the recommendations on the last inspection report have not been actioned. These were around the provision of some sort of annual holiday away Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 Page 17 from the home for some of the younger adult residents. There as also a recommendation made around the consideration of the provision of transport so that younger adults can better access the community and likewise the position remains unchanged. Interviews however evidenced some progress in that residents generally are now going out fairy regularly with staff support. The home has now got two full time activities co coordinators and the provision and organisation for activities for residents has vastly improved. This is particularly so on the Bedford unit who now have some input on a daily basis. The staff responsible are enthusiastic and have organised regular social events as well as the daily activities. Residents spoke warmly of the recent 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. The home has a pleasant dining room for general elderly and younger adults and meals were observed to be social occasions. One resident 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. A two-hour observational inspection was carried out in the dementia unit. This involved watching how residents and staff interact with each other. The feedback from this was discussed with the manager. Some good interactive skills were observed with some staff on the unit. The observations did highlight that some residents, when the opportunity arose, did not receive social reinforcements by staff. For example one resident who displays very withdrawn behaviour was given a cup of tea but the staff member did not take the opportunity to have any verbal interaction. Other examples were discussed with the manager of the unit and consideration should be given to feeding back such observations via discussion with staff and through supervision. Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 Page 18 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): 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. Complaints are recorded and there have been 3 complaints since the last inspection that have been investigated by the manager and / or CSCI. 2 of the complaints were not upheld and one, investigated by the manager was upheld. Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 Page 19 One complaint centred on the admission of an elderly confused resident to casualty. This was investigated by CSCI and social services as the referral was made through the adult protection policy. The allegation centred on poor care and possible neglect. This complaint was not upheld although there were recommendations made by the inspector around the escorting of elderly confused residents to hospital the manager has since changed the policy in this area. Another complaint concerned the care of a younger adult and was around the alleged poor management of an acute psychiatric episode. This was unfounded, as the appropriate referrals had been made. The last compliant was around the management of a residents catheter and involved personal care issues. The manager founded this and practice was reappraised. 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. Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 Page 20 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): 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. EVIDENCE: Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 Page 21 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. This includes the development of a shower room on the first floor and the upgrading of the laundry to ensure easier management and cleaning. 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. There were some minor issues discussed with the manager which need addressing: • • • The toilet situated on the upstairs elderly unit had waste bins with no covers. There was therefore a slight smell in this area. Some of the chairs in the Bedford unit day room were looking in poor condition [pointed out at the time]. A lot of the bedroom doors were not identified with either residents names or room numbers. Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 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): Key standards The quality in this outcome group is adequate. This judgement is made on the available evidence including the site visit. 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 46 residents at the time of the inspection. Most of these were highly dependant. The units were staffed with 2 trained nurses and 12 care staff. These numbers fluctuate at times in the day and were listed on the duty rota. The numbers were consistent over the 3 days of Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 Page 23 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 carers. 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. Comments were positive; ‘ marvellous nursing when I was ill’, ‘staff are wonderful – this is a happy and safe haven’. The manager is supernummery to these figures. The turnover of staff, particularly nursing staff, has stabilised and the staff generally are consistent and experienced. Domestic and kitchen staff are also employed and the home also has two staff members who organises activities in the home. Staff files were seen and the recruitment of staff was discussed. As on the previous 2 inspections the staff files were inconsistent in the amount of information detailed. On this inspection 2 staff did not have the appropriate checks prior to commencing work in the home. 1 staff member’s file had no written references [only verbal] and no Criminal Records Bureau [CRB] check on file. Another staff member [carer] was working in the home at the time of the inspection without CRB or Protection of Vulnerable Adults [POVA] check on file. The manager explained that this staff member was being supervised [subsequently did not work in the home]. The administrator also explained that the company are in the process of running CRB checks on overseas staff as they originally thought that these were not required. This is the third consecutive inspection that staff records have been incomplete. Currently one administrator is covering 2 homes in the group and the provider and manager may need to review workload given the ongoing problems. Training files were seen for some of the staff and 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. 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.V311040.R01.S.doc Version 5.2 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): Key standards The quality in this outcome group is good. This judgement is made on the available evidence including the site visit. The registered manager is qualified and competent and resident’s benefit from well managed care. Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 Page 25 There are quality assurance processes in place so that resident’s views are taken into account in the running of the home. The health and safety management is effective and the welfare of residents is promoted and protected. 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. Thee 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. The minutes of the last meeting were seen. Residents finances are managed through the administrator in the home. Those residents interviewed were happy that they receive there benefits and that they could access any funds fairy quickly. Most of the residents manage their own affairs to some degree. 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. There was some discussion with the deputy manager, who is responsible for aspects of health and safety, regarding the management of legionella in the home. The home has commissioned an inspection and subsequent report on the water system in the home and there are some recommendations following this. There was discussion also with the owner and these will be followed up. Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 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 2 2 2 3 3 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 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 2 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.V311040.R01.S.doc Version 5.2 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 Standard OP1 Regulation 5 Requirement The service user guide for the home must be updated and made available with reference to the comments in this report as well as schedule 1 of the care homes regulations. All residents must receive terms and conditions of residency including the amount and method of payment of fees. An accurate record of the receiving and administration of all medicines must be maintained. 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 2 requirement dates of 21.1.05 and 05.01.06 not met] Timescale for action 01/02/07 2 OP2 5 01/02/07 3 OP9 13[2] 17[a] 1 19 13/12/06 4. OP29 13/12/06 Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 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 3 Refer to Standard OP3 OP12 YA13 Good Practice Recommendations All assessments should be signed and dated and referenced appropriately. The feedback from the observational tool on the dementia care unit should be discussed with staff as part of ongoing development. 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 environmental issues listed in the report should be attended to. The recommendations in the report on the water system and management of legionella should be actioned. 4 5 OP19 OP38 Manchester House DS0000017249.V311040.R01.S.doc Version 5.2 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.V311040.R01.S.doc Version 5.2 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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