Inspection on 11/07/07 for Palatine Lodge

This inspection was carried out on 11th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Palatine Lodge 20/05/09

Palatine Lodge 26/11/08

Palatine Lodge 02/01/08

Palatine Lodge 19/09/06

Palatine Lodge 23/02/06

Palatine Lodge 11/10/05

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

CARE HOMES FOR OLDER PEOPLE Manderley Residential Care Home 17/19 Palatine Square Burnley Lancashire BB11 4JF Lead Inspector Mrs Julie Playfer Unannounced Inspection 09:30 11th July 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manderley Residential Care Home Address 17/19 Palatine Square Burnley Lancashire BB11 4JF 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) 01282 431450 manderleymanager@gmail.com Dr Morgiana Muni Nazerali-Sunderji vacant post Care Home 15 Category(ies) of Dementia (10), Learning disability (5), Mental registration, with number disorder, excluding learning disability or of places dementia (10) Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service must employ a suitable qualified and experienced manager who is registered with the Commission The home is registered for a maximum of 15 service users to include: Up to 10 service users in the category of MD Up to 10 service users in the category DE Up to 5 service users in the category LD No new service users under the age of 55 years will be admitted to the home. 19th September 2006 3. Date of last inspection Brief Description of the Service: Manderley Residential Care Home is a large 2 - storey Victorian style property, situated close to the town centre and its amenities and bus stops. The garden areas are ramped to allow easy access for residents. Accommodation consists of 11 single and two double rooms. As a home in existence prior to the implementation of the National Minimum Standards in April 2002, Manderley was exempt from having to meet some of the Standards relating to room sizes. The upper floor is accessed via a stair lift. There is equipment and adaptations available to assist the residents with mobility problems. All rooms are linked to the call system. At the time of the inspection, the scale of fees ranged from £310.50 to £493.00. Additional charges were made for hairdressing, chiropody, toiletries and activities outside the home. Information was made available to prospective residents by means of a statement of purpose and service users guide. The service users guide was usually given to prospective residents and/or their relatives on viewing the home or at the point of assessment. Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Manderley Residential Care Home on 11th July 2007. At the time of the inspection there were 13 people accommodated in the home. The inspection comprised of spending time with the residents, looking round the home, looking at the residents’ care records and other documents and discussion with the staff and the acting manager. As part of the inspection process the inspector used “case tracking” as a means of gathering information. This process allows to the inspector to focus on a small group of people living at the home. Prior to the inspection the acting manager completed a detailed questionnaire, which provided useful information and evidence for the inspection. Satisfaction questionnaires were sent to the home for the residents and their relatives. One questionnaire was returned from relatives/visitors to the home and seven questionnaires were received from the people who live in the home. In addition a survey was sent to visiting health professionals to the home, two forms were returned. Information supplied by the home prior to the inspection, clearly indicates that 6 people have been placed in the home outside the categories of registration. This matter is being taken up with the registered provider as a matter of urgency and is of serious concern to the Commission. Information supplied by the home prior to the inspection, clearly indicates that 6 people have been placed in the home outside the categories of registration. This matter is being taken up with the registered provider as a matter of urgency and is of serious concern to the Commission. What the service does well: Prospective residents were encouraged and supported to visit the home, before making the decision to move in. This provided the opportunity to meet the other residents, have a look round the home and sample the meals. The residents spoken to liked the staff, who one person described as “wonderful”. The residents felt the staff respected there privacy and dignity. The daily routines were flexible and designed to meet the needs of the residents. As such the residents were able to choose when they went to bed and when they got up in the morning. Activities were arranged in line with the needs and preferences of the residents, which included trips out in local area. The residents liked all the meals, which they described as “very good” and “marvellous”. Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 6 Visitors were made welcome anytime and the residents were supported to maintain good contact with their families. The residents were provided with clean, nicely decorated bedrooms. The residents could personalise their rooms, with their own belongings. The sitting and dining areas were decorated in a homely and comfortable fashion, with a variety of armchairs, foot stools, side tables, ornaments and pictures. A good percentage of staff had achieved NVQ level 2, this qualification provided the staff with the necessary training to carry out their role effectively. What has improved since the last inspection? What they could do better: Following an assessment of needs the registered person must inform new residents in writing that their needs can be met within the home. This is to assure residents that they will be supported and cared for appropriately should they choose to move into the home. The registered person must ensure that people admitted to the home fall with the categories on the Certificate of Registration and, as defined in the statement of purpose. The registered person should set out the criteria and process for moving rooms in the home in the contract. This is to safeguard the wishes of the residents and ensure their needs are met and their choices respected. Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 7 All residents must have a care plan setting out their current needs, including their healthcare needs. The plans must also include guidance for staff on how best to meet the residents’ needs. Without such plans the residents may be cared for in an inconsistent and unsafe manner. In order to safeguard the residents, risk assessments must include instructions for staff on how to minimise or reduce any identified risk. The risk assessments must be kept under review and updated in line with the residents’ changing needs and conditions. A record must be maintained of the incidence of pressure sores and of the treatment provided for each resident. This is to ensure such conditions are monitored and treated appropriately. A plan must be maintained in respect of a resident’s specialist nutrition needs and staff must be provided with guidance on how best to meet these needs, to ensure the resident is safe and is kept nourished. Significant improvements must be made to the overall management of medication, to ensure the residents receive their medication in line with the prescribers’ instructions and the records are accurate and up to date. When recruiting new staff the registered person must ensure that all appropriate records and checks are obtained in line with legal requirements. This is to ensure the residents are protected and the staff are fully vetted before working in the home. As the home has been without a registered manager since October 2005, an application must be made to register a manager with the Commission. This is the ensure that a person is registered at the home to take legal responsibility for the day to day running and management of the home. Documentation must be produced to confirm the work recommended by the electrician in May 2006 has been undertaken and the electrical installations have been retested. Appropriate equipment must be provided at all times to meet the moving and handling needs of the residents. This is to ensure the safety the residents and staff. 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. Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents were not always provided with written information suitable for their needs and new residents were not assured their needs could be met within the home. EVIDENCE: Written information was available for residents in the form of a statement of purpose and service users guide. Since the last inspection both documents had been updated in line with regulatory requirements and the change of manager. The service users guide had been supplied to residents and was available in their bedrooms. However, the guide was presented in one detailed written format, which two residents said they couldn’t understand or read. Three personal files were inspected as part of the case tracking process, it was apparent that all three residents had been issued with a contract with the registered provider, which included information about the current level of fees. Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 10 The contracts had been signed and dated. However, it was noted that one resident had been issued with two contracts within ten months showing different room numbers. There were no criteria in the contract or written procedure seen relating to moving rooms within the home. This meant the residents could be potentially moved to a room, which did not meet their needs and was not of their choice. The records of one resident admitted into the home since the last inspection indicated that a social work assessment had been received on the day of admission. Further to this, a copy of a preadmission assessment carried out by the registered provider was seen after the inspection. However, there was no documentation seen to demonstrate the resident had received written assurances, following the assessment, that her needs could be met within the home. The resident was supported by the manager to visit the home prior to admission. This provided the opportunity to discuss her needs, meet staff and residents and view the vacant room. The resident recalled her visit to the home and said “everyone was very friendly, I liked it all”. Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Information about the residents’ current needs was not in sufficient detail to ensure all health and personal care needs could be met. The management of medication placed the residents at risk of harm. EVIDENCE: From the three personal files seen it was evident that each resident had a recent assessment of needs. However, only one person had an up to date care plan, which reflected their current needs and included guidance for staff on how best to meet their needs. The two residents without a current care plan prepared by the manager and staff, had complex needs and staff had very limited written information about how to care and support these people in a safe and consistent manner. The two care plans were being devised at the time of the visit, but had not been completed and were not available to staff. The care plans were supported by the records of personal care, which provided information on changing needs and any recurring difficulties. Since the last Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 12 inspection, these records had been maintained on a daily basis and provided good information about the residents’ well being. Health care needs were addressed in the care plan seen and all residents were registered with a General Practitioner. However, the health care needs of two residents were not set out in a care plan and there was no guidance for staff on how best to meet these needs. The records of personal care indicated that residents had access to NHS services, including the District Nursing Team. Risk assessments had been carried out in respect to moving and handling, nutrition, pressure sores and falls. However, the risk assessments had not always been reviewed and updated to reflect changing needs. For instance, one person’s moving and handling assessment had not been reviewed and updated following a significant change in his needs. In addition, there were no management strategies seen to monitor and treat pressure sores. The nutritional needs of one person were unclear, although a fluid intake chart had been maintained, there was no documentation seen to demonstrate this person had been given thickened fluids as directed by the hospital. Further to this, there was no guidance for staff on how to use the thickening powder appropriately and safely. The inspector noted this resident was given water without thickening powder, in a syringe, on the day of the visit, which could pose a significant risk to health and well being of the person. One resident was using incontinence aids, however, there was no information or guidance seen for staff on what size of pads were used and how frequently the pads required changing. A chart was maintained for each resident to monitor any fluctuations in weight. The residents spoken to felt the staff respected their right to privacy and all made complimentary comments about the staff and manager. For instance one person said “the staff are wonderful, they treat me really well”. The staff were observed to interact with the residents in a positive manner and they referred to the residents in their preferred mode of address. The home operated a monitored dosage system for the administration of medication, which was dispensed into individual blister packs. Since the last inspection, the policies and procedures had been updated to reflect practice in the home. Appropriate records were in place for the administration and disposal of medicines. However, there was no record of receipt of medicines in the home. This meant it was not possible to trace an audit trail, to ensure medication had been administered correctly. There were two types of medication not available in the home, which meant these residents were not receiving their medication as prescribed, there were several omissions on the medication administration record (MAR), where medication had not been signed as given and there was one type of medication in the trolley not labelled with a prescription label. Information on the MAR chart did not always Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 13 correspond accurately to the details on the prescription label and there was no written criteria seen for the administration of drugs prescribed as necessary. In addition, the controlled drugs register did not correspond to the stock of medicine of the premises and there was no record of controlled drugs when they were received into the home. Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were able to pursue social activities and supported to keep in contact with their friends and family. Residents received a healthy and varied diet according to their requirements and choice. EVIDENCE: All the residents spoken to said the daily routines were flexible and they were able to get up and go to bed at a time of their choosing. One person said, “it depends what’s on the telly, what time I go to bed”. The residents were supported to practice their religious belief and several residents attended church on a regular basis. A Priest also visited a resident on the day of the inspection. Whilst two residents told the inspector, “there was not much going on”. The record of daily care and discussions with other residents and the staff demonstrated that the residents pursued a variety of activities. These included going shopping, visiting a local social club and attending luncheon club. The residents also said they recently enjoyed a recent visit by a country and western singer and playing dominoes and cards. One resident particularly Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 15 enjoyed drawing and showed the inspector pictures he had drawn during the inspection. One person had recently been abroad on holiday with two members of staff, the person said she had “an absolutely wonderful holiday”. There were no restrictions on visiting and the residents were able to entertain their guests in private. The relative who returned a questionnaire expressed satisfaction with the service and care provided and commented “Manderley appears to be a pleasant, friendly place for my relative to live. The staff are extremely professional and conscientious”. Residents were encouraged to exercise choice and control over their lives. The residents were consulted on an ongoing basis about their choices in daily living and more formally at residents meetings. The residents were supported and assisted to manage their finances. The residents were also able to bring in personal belongings and arrange their rooms how they wished. The residents were provided with three main meals a day and choice of meals was discussed prior to each meal. Staff were observed asking the residents what they wished to eat on the day of the inspection. The meal was homemade, well presented and looked appetising. The residents were satisfied with the quantity and variety of meals and described the food as “lovely” and “very good”. One person commented, “the food is marvellous, I love it, I like everything”. The record of meals provided was complete and up to date. Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place to ensure any concerns of residents would be listened to and acted upon. Policies and procedures were in place to respond effectively to any allegations or suspicions of abuse. EVIDENCE: A complaints procedure was included in the statement of purpose and service users guide. A pictorial version of the procedure was displayed in the residents’ bedrooms. The residents said they would speak to a member of staff or the manager in the event of a worry or concern. There have been four complaints of a serious nature made about the service, since the last inspection. One complaint was received recently by the Commission. The other complaints had been investigated, in accordance with the internal complaints procedure, by the registered provider and other agencies, as appropriate. Detailed records were maintained of the complaint investigations. A copy of No Secrets in Lancashire, (The joint strategy for the protection of vulnerable adults) was available, along with a specific procedure setting out the required response in the event of any allegations or suspicion of abuse. This procedure had been updated since the last inspection. Staff had access to a whistle blowing policy and had recently received Protection of Vulnerable Adults training. Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the environment provided for residents was clean and pleasant, the physical layout of the building had the potential to limit the residents’ independence. EVIDENCE: Manderley is a mature property set in its own grounds. The home is located within a mile of the town centre. Accommodation is provided in 11 single bedrooms and 2 double bedrooms, none of the bedrooms have an ensuite facility. Some of the bedrooms do not meet the space requirements set out in the National Minimum Standards, which has the potential to limit the use of appropriate equipment for moving and handling purposes. (See under management and administration). Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 18 The first floor is accessed by a stair lift. Communal space is provided in two lounges and a dining room. The residents had access to gardens, which included seating areas. It was evident from a partial tour was of the premises that residents had personalised their rooms with their own belongings and decoration was good throughout. The residents spoken to said, they liked their rooms, which they said were comfortable and warm. One resident said she liked to sit by her window and “get some fresh air”. Some of the wardrobes had been replaced, however, one wardrobe seen was wobbly and not secured to the wall. Since the last inspection, the lounges and dining room had been redecorated, the external woodwork had been painted and the gardens had been maintained. A weekly inspection was undertaken of each room by the handyman, in order to identify any repairs needed. Records had been maintained of the work carried out. The residents’ doors were fitted with appropriate locks and keys had been distributed to the residents as appropriate. There was documentation seen on the personal files to demonstrate the keys had been discussed with each resident. The standard of cleanliness was good in all areas seen and appropriate equipment was in place to do the residents’ laundry. All residents spoken to said the home was kept clean and tidy. Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff received appropriate training to enable them to support the residents, however, the recruitment process was not robust and staff were not always fully vetted. EVIDENCE: The manager completed a staff rota, which was completed in advance. All staff carrying out care duties was aged at least 18 and all staff left in charge of the building were aged at least 21. The files of two members of staff, who had commenced work in the home since the last inspection were examined. Both staff had completed an application form and attended the home for an interview. However, it was noted that one member of staff had not supplied the home with a full working history, together with a written explanation of any gaps in her employment and she had commenced work in the home prior to receipt of the second written reference. Appropriate POVA (Protection of Vulnerable Adults) and Police checks had been received prior to employment in the home. The new staff had been issued with a staff handbook, which contained the relevant policies and procedures and the Code of Conduct set by the General Social Care Council. Arrangements were in place for the induction and supervision of new staff. Since the last inspection, a structured induction programme had been Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 20 introduced based on the “Skills for Care” standards. A member of staff spoken to said, he was currently completing a work booklet and confirmed he had found his induction useful and informative. Each member of staff had a training and development, which they discussed during the supervision process. At the time of the inspection, eight staff had achieved NVQ level 2 or above, this equated to 72 of the staff team were trained. In addition, a further four staff were working towards this qualification. Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The residents lacked the benefit of a registered manager. The health and safety of residents was put at serious risk by the use of inappropriate moving and handling techniques. EVIDENCE: Significant aspects of the overall management of the home were poor. These included the admission of residents outside the registration criteria, the systems used to plan and deliver appropriate care and the overall management of medication. Since the last inspection, there had been a change of manager. The current manager commenced working in the home in January 2007 and was working towards the Registered Manager’s Award. The manager had not been provided Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 22 with a job description and at the time of the inspection had not submitted an application to the Commission to apply to be the registered manager. The home has been without a registered manager since October 2005. Relationships within the home were good and staff spoke about the residents with respect. The residents valued the help and support they received from the staff, who they described as “good” and “the best staff we’ve had for a while”. A programme of staff supervision had been established, which enabled staff to discuss their work in the home and future training needs. The staff also received an annual appraisal of their work performance and were given the opportunity to attend staff meetings. Since the last inspection, the service had been awarded an Investors in People Award. Satisfaction questionnaires had been distributed in June 2007 to the residents and their relatives. To assist the residents some questionnaires had been produced in a pictorial format. Completed questionnaires were seen during the inspection. The results of the surveys had been collated and the manager was due to produce an action plan based on the results. Since the last inspection, residents meetings had been introduced on a regular basis. Minutes were seen of the meetings and it was apparent a wide variety of topics had been discussed. However, there were systems in place to audit the management of medication in the home. Appropriate arrangements were in place for handling money, which had been deposited in the home by or on behalf of the residents. A random check of monies was found to be correct. There was a set of health and safety policies and procedures available, which had been reviewed and updated since the last inspection. Staff had received health and safety training, which included moving and handling, food hygiene, fire safety and first aid. Training certificates were seen on a sample of the staff files. Documentation seen during the inspection confirmed the fire system, portable electrical appliances and gas installations had been tested and serviced at appropriate intervals. However, the electrical safety certificate dated May 2006, stated the electrical installations required testing again following the completion of remedial work. There was no documentation seen to demonstrate this work had been carried out or the systems had been rechecked. There were records to demonstrate the fire system had been tested on a weekly basis and a record of fire drills was sent to the Commission following the inspection. From inspection of one resident’s personal care records, it was apparent that staff were using inappropriate techniques to move the resident. One entry read “**** not standing at all, swinging on your arms”. At the time of the entry in the care records, the resident was accommodated in a first floor room, which meant the staff had no access to the hoists, as these were located on the ground floor. Consequently, staff had to manually move and transfer this Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 23 resident who at times was not able to bear his weight, putting themselves and the resident at significant risk. Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X 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 3 X X 2 3 2 X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 2 X 3 3 X 1 Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 OP4 Regulation 14(1) (d) Requirement New residents must be informed in writing, prior to admission that having regard to their assessment their needs can be met within the home. All residents must have a care plan, which reflects their current needs. So that staff have specific guidance on how best to meet the residents’ needs. The residents’ healthcare needs must be clearly set out in a care plan, to ensure staff are aware of how best to respond to the residents’ medical conditions. Risk assessments must include management strategies, in order for staff to be aware of how to reduce or eliminate any identified risks. The risk assessments must be kept under review and updated in line with changing needs. A record must be maintained of the incidence of pressure sores and of treatment provided to the resident. A plan must be maintained relating to the resident in respect DS0000064567.V339061.R01.S.doc Timescale for action 11/07/07 2 OP7 15 (1) 11/07/07 3 OP8 15 (1) 11/07/07 4 OP8 13 (4) (c) 15/07/07 5 OP8 17 (1) (a) Schedule 3 (3) (n) 17 (1) (a) Schedule 11/07/07 6 OP8 11/07/07 Manderley Residential Care Home Version 5.2 Page 26 3 (3) (m) 7 OP9 13 (2) of nutrition. Staff must be provided with specific instructions on how to use of the thickening powder safely and consistently. A record of receipt of all medication must be maintained, to ensure an audit trail can be traced of all medication received into the home, including controlled drugs. Prescribed medication must be available on the premises at all times to ensure the residents receive the correct medication. Staff must sign the medication administration record contemporaneously, so an up to date record of the administration of medicines is maintained. All medication must have a prescription label to ensure it is administered to the correct person in the correct dose. 11/07/07 8 OP29 The controlled drugs register must be accurate and up to date at all times. So a clear audit trail can be traced. 17, 18, 19 All records and checks for new 11/07/07 Schedule members of staff must be 2 (as collated and maintained in line amended) with the Care Homes Regulations 2001. This includes obtaining a full working history along with a written explanation of any gaps in employment and ensuring two written references have been received prior to the commencement of employment. This is to ensure the staff are properly vetted and the residents are fully protected. (Previous time scale of 19/11/06 – not met). DS0000064567.V339061.R01.S.doc Version 5.2 Page 27 Manderley Residential Care Home 9 OP38 13 (4) The registered person must provide documentation to confirm the remedial work has been carried out to the electrical installations and a new electrical safety certificate has been obtained. This is to protect the health and safety of the residents and staff. Appropriate equipment must be provided at all times to meet the moving and handling needs of the residents. To ensure the safety of the residents and the staff. 11/08/07 10 OP38 16 (2) (c) 11/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. Refer to Standard OP1 OP2 Good Practice Recommendations The service users guide should be presented in a format, which is suitable for the needs of the residents. This is to ensure the guide is meaningful to the residents. The contract should clearly set out the criteria for moving rooms and include details how the resident will be consulted during this process. Criteria should be set out to detail the circumstances of the administration of medication prescribed as necessary. This is so this type of medication is administered in a consistent manner in line with the needs of the residents for which it was prescribed for. The wardrobe in one of the bedrooms should be stabilised and secured to the wall, to prevent it falling from a resident. An audit system should be established to monitor the management of medicines in the home. This is to ensure a clear audit trail can be traced of all medication. 3 OP9 4 5 OP24 OP33 Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway 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 Manderley Residential Care Home DS0000064567.V339061.R01.S.doc Version 5.2 Page 29 - 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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