Inspection on 23/02/06 for Palatine Lodge

This inspection was carried out on 23rd February 2006.

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 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

Palatine Lodge 20/05/09

Palatine Lodge 26/11/08

Palatine Lodge 02/01/08

Palatine Lodge 11/07/07

Palatine Lodge 19/09/06

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 Pat White Unannounced Inspection 23rd February 2006 09:30 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.V284972.R01.S.doc Version 5.1 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.V284972.R01.S.doc Version 5.1 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 Dr Morgiana Muni Nazerali-Sunderji 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.V284972.R01.S.doc Version 5.1 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. 11th October 2005 3. Date of last inspection Brief Description of the Service: Manderley 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. Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection, the purpose of which was to assess important areas of life in the home that should be inspected over a 12 month period, to check the legal requirements and recommendations from the previous inspection and to check other matters which came to the inspector’s notice. The inspection took 8 hours 15 minutes, and comprised of spending time with the residents, looking around the home, looking at residents’ care records and other documents, and discussion with the acting manager. Two members of staff were also spoken with. A district nurse and one relative was spoken with during the inspection. Comment cards about the home were left in the home for residents and relatives to complete and return to the CSCI but none were received at the time the report was written. What the service does well: Staff worked hard to make the residents comfortable and happy. One resident who could talk to the inspector said that they were well cared for and that staff were good and kind to them. One visitor to the home said that the staff worked extremely hard to make sure all the residents were well looked after. There was detailed and useful written information about how the residents should be looked after and what they liked to do each day. Residents were encouraged to do as many things for themselves as possible and to choose what they wanted to do and where they wanted to go. One resident said she enjoyed doing things on her own, or with the help of staff. The staff made sure that the residents had all the medical and nursing attention they needed and a district nurse who spoke to the inspector said that Residents had a good standard of care at Manderley. The way the staff organised the residents’ medication and the way the residents took their medication was done safely, and helped to make sure they were kept as healthy as possible. The home was nicely decorated, clean and well kept and residents were able to choose their own decorating and furnishings. They could bring small personal items of furniture with them and other personal possessions. Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 6 All staff are properly taught how to look after the people who lived at Manderley, and they were able to do it well. The acting manager and the owner also made sure that only the right kind of staff were allowed to work in the home. What has improved since the last inspection? What they could do better: The home does not have a registered manager. Application must be made to the Commission. In the meantime the home owner must visit the home more regularly to give support to the acting manager, and the reports sent to the Commission about these visits must clearly show this. The written information of residents’ care needs could be further improved, with more details written down about what staff needed to do to look after them. This should be reviewed more regularly. This will make sure all care needs are known to staff and can be met. The way the home manages and administers medication could be further improved to make it safer. There must always enough staff on duty so that the staff have time to spend with the residents and are not always too busy to do things with them. There should also be enough staff in the team so that people do not have to work too many hours. Please contact the provider for advice of actions taken in response to this Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 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.V284972.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 4. Standard 6 is not applicable Before people go to live in the home an assessment of their needs is undertaken to help decide whether or not the home is suitable for them EVIDENCE: Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 10 The records of the most recently admitted resident showed that the social work assessment had been received, and that the acting manager had undertaken an in house assessment, prior to admission. However a detailed plan of care with respect to mental health issues had not been written. The residents living at Manderley had a wide range of different needs, associated with dementia, learning disability and mental disorder. One resident was terminally ill and required all care in bed. The inspection demonstrated that the home could meet these individual needs through assessments, staff training and expertise and care practices. There was evidence that staff had undertaken training in dementia, mental health and challenging behaviour. Some staff could use Makaton. However on the day of the inspection there was a member of staff short (see standard 27) and this made it difficult for the staff to meet the needs of the residents. One relative stated that she had noticed that the staff were working very hard and long hours to ensure the residents needs were met and to keep up the high quality of care the residents had been used to. The home operated a key worker system, which facilitated continuity of care for the residents. The home does not provide intermediate care. Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Staff understand the residents’ health and personal care needs, and medication was managed safely. EVIDENCE: The viewing of records showed that the residents had a comprehensive care plan that included a detailed “preferred daily routine”. The care plans contained useful detail regarding the residents’ capabilities, limitations, psychological / emotional issues and their needs in terms of support and assistance and daily activities. Risk assessments were also completed, for example in moving and handling and vulnerability to pressure sores. However one care plan viewed did not have sufficient detail regarding how to manage aggressive behaviour. Some other care plans needed reviewing and updating. The residents’ physical and psychological health was monitored and health needs were addressed. The district nurses attended the home for any clinical nursing procedure the residents required. A district nurse was spoken with and confirmed that the staff at Manderley ensured a good standard of care for Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 12 the residents, that there was good liaison between them and that they followed all the advice given. Risk assessments regarding pressure sores had been undertaken and preventative and remedial measures were recorded appropriately on the care plan. Residents had access to specialist continence advice and care. Some residents had mental health assessments and intervention by the mental health services. Nutrition assessments were undertaken, and matters of concern regarding eating issues, diet and weight were also monitored and recorded. The management and administration of medication in the home was in general carried out safely. There were comprehensive policies and procedures that covered all aspects of practice. Areas of good practice included, record keeping, verifying the medication with the GP on admission and the home checking the prescriptions prior to dispensing. However there were some unexplained gaps in the MAR sheets, alterations to the MAR sheets following changes in medication were not being witnessed and signed by two members of staff and medication for one resident discussed was omitted without clarification of the reason and written instructions from the GP. There was evidence that the residents’ rights to privacy and dignity were upheld. Staff were seen treating residents with respect and kindness, and this was especially evident with a resident who was being cared for in bed at the end of her life. Records showed that she had received all the necessary medical and nursing intervention. Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 & 15 Residents are assisted to exercise choice and control over their lives. The food served was healthy and varied and based on residents’ likes and preferences. EVIDENCE: One resident was managing her own financial affairs, with assistance. All other service users had some degree of intellectual impairment and were deemed not to be capable of managing their finances. Information about advocacy was included in the service user guide. Residents could have access to their personal records in line with the home’s policy, which was in accordance with the Data Protection Act 1998. Residents could bring some personal possessions with them and a list of the items brought was kept in the case files. Residents were encouraged to assist staff in the refurbishment and decorating of bedrooms. The home also encouraged autonomy and choice through residents’ meetings. Residents were ageing and were choosing to spend more time in the home, but one resident was able to go into town on the bus on her own. Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 14 The food served was according to residents’ tastes, preferences and needs. It looked wholesome and nutritious. Three full meals were served each day and there was a choice of two main cooked meals. A variety of options were always available for the snack meal. Menus changed frequently according to residents’ preferences and seasonal variations, and which were discussed at residents’ meetings. Appropriate assistance was given to those who needed it. Since the previous inspection records of food served at supper - time was being recorded, and when meals were mashed/blended the individual foods were blended and presented separately. Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None The standards in this section were not assessed EVIDENCE: Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 Manderley provided safe, well - maintained and clean accommodation EVIDENCE: The tour of the premises showed that the home was well maintained and decorated. Following an audit of disability equipment in the home the owners had decided to purchase a hoist. The home was clean and fresh with appropriate laundry systems in place for the control of infection. Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 Though staff were trained and competent, there were not sufficient staff on duty at all times to meet the needs of the residents. EVIDENCE: Staffing numbers on the morning of the inspection were not sufficient for meeting the needs of the residents. A rostered member of staff did not come in to work because of sickness. A cook was working in the home and was assisting with care hours. The staff on duty stated that some staff members had recently been working long hours/ extra shifts to cover sickness and staff vacancies. The acting manager stated that new rotas had been devised and shifts were now covered. A relative spoken with stated that she was concerned that staff were working long hours to cover shift vacancies and they looked tired and low in morale. However, she also stated that she felt the staff were working very hard to maintain the high standard of care of the residents. Due to staff vacancies and pressure on the existing staff in covering shifts, two new members of staff were appointed following the receipt of POVA checks but prior to the CRB disclosure being returned. The home was following the guidance for employing people prior to CRB checks being returned. Staff training and development records showed that staff had attended a variety of relevant training courses in accordance with their own needs and Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 18 those of the residents. These included the Skills for Care based Induction training, moving and handling training, first aid, infection control, food hygiene and palliative care. Some of this training was in need of updating such as moving and handling, medication and first aid. This was being arranged with a training provider and consultant who was also working in the home. Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 32 The management of the home was going through a difficult period of change and would benefit from strong leadership. Application must be made to register a manager to ensure a consistent service. EVIDENCE: Manderley had gone through a period of considerable change. A new owner purchased the home in July 2005 and the Registered Manager had left the home in November. There had been an acting manger since that time. She was a previous senior carer in the home and was studying for NVQ level 4 qualifications. As relatively inexperienced in management the acting manager felt she needed considerable support from the owner. In order to demonstrate support to the acting manager through this change of role, the owner must ensure that the monthly reports, sent to the CSCI under the Care Homes Regulations, reflect the support given. The Commission will monitor this support. Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 20 Application to register a manager must be made to the Commission to ensure consistency. All the staff spoken with stated that they were low in morale due to working a lot of extra shifts and also because they felt there was a lack of leadership and support. Standard 38 was not assessed but it was established that the home’s water supply was tested and found free from Legionella Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x 3 X X 3 X X X 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 X X X X X x Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) Requirement The registered person must ensure that the care plans contain enough detail on all aspects of the residents’ health and personal care needs, including those relating to mental health. The care plans should be reviewed at least monthly and updated as required All medication administered must be entered on the MAR sheets All hand written alterations on the MAR sheets, including those resulting from a change in medication should be witnessed and signed by two members of staff There must be written clarification and details of the GPs authorisation when medication is omitted. There must be sufficient staff on duty at all times to meet the needs of the residents Application must be made to register a manager with the CSCI. Monthly reports sent to the DS0000064567.V284972.R01.S.doc Timescale for action 31/03/06 2 3 4 OP7 OP9 OP9 15 (2)(c) 13 (2) 13 (2) 31/03/06 23/02/06 23/02/06 5 OP9 13 (2) 23/02/06 6 7 8 OP27 OP31 OP32 18 (1)(a) 8 26 23/02/06 28/04/06 23/02/06 Page 23 Manderley Residential Care Home Version 5.1 Commission must contain a full audit of findings so as to offer good support to the acting manager. This must be demonstrated in the report. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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 Manderley Residential Care Home DS0000064567.V284972.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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