Inspection on 16/05/08 for Manley Court Nursing Home

This inspection was carried out on 16th May 2008.

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

Manley Court Nursing Home 17/10/07

Manley Court Nursing Home 07/06/06

Manley Court Nursing Home 12/12/05

Manley Court Nursing Home 21/06/05

Manley Court Nursing Home 26/10/04

Manley Court Nursing Home 15/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Manley Court Nursing Home Manley Court John Williams` Close, Off Cold Blow Lane New Cross London SE14 5XA Lead Inspector Lynne Field Key Unannounced Inspection 16th, 20th & 22nd May 2008 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 Manley Court Nursing Home DS0000006997.V363356.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. Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manley Court Nursing Home Address Manley Court John Williams` Close, Off Cold Blow Lane New Cross London SE14 5XA 020 7635 4600 020 7639 9433 laminat@bupa.com www.Bupa.co.uk Bupa Care Homes (ANS) Ltd 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) Care Home 85 Category(ies) of Dementia (36), Old age, not falling within any registration, with number other category (49), Physical disability (49) of places Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 49) Dementia - Code DE (maximum number of places: 36) 2. Physical disability - Code PD (maximum number of places: 49) The maximum number of service users who can be accommodated is: 85 17th October 2007 Date of last inspection Brief Description of the Service: Manley Court is a purpose built home providing care and nursing for up to 85 service users, of whom 36 may have dementia, 49 may be frail older people, of whom 6 may be in receipt of palliative care and 14 may be aged over 40 yrs of age and have a chronic illness. The private, nationwide company BUPA Care Services took it over from Associated Nursing Services (ANS) owns the home. It is situated in a residential area of New Cross Gate. The nearest shops and railway station are ten minutes walk away. The nearest bus stop is several minutes walk away. The home was opened in 1996 and is on two floors. It is divided into five units of which two provide nursing care. There are two units for people with dementia and a small unit with rooms for people in need of palliative care nursing. All the bedrooms are single with en-suite facilities. There is a passenger lift. The home has two gardens at the rear that are accessible and secure. There is car parking at the front of the building. The home has a brochure and a resident’s guide that is made accessible to all prospective residents and the families. Copies of CSCI reports are kept in the Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 5 reception area and a copy is given to service users, relatives or a representative on request. The home’s fees range from £640 - £944-50 a month. Additional charges are made for hairdressing, toiletries, newspapers, outings, taxis and clothing. This information was collected during the May 2008 inspection. Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star, which means that people using the service receive a good service. This key inspection was conducted by one inspector and took place over three days. The pharmacy inspected the medication systems in the home as part of the inspection on two separate days in June 2008. This report will be sent separately. The inspection involved observing interaction between residents and staff during the inspection, speaking twenty residents, five relatives, the staff on duty on each of the days of the inspection and the manager. Care managers, social workers and advocates were spoken to during the inspection and afterwards on the telephone during and after the inspection as part of the inspection process. We spent sometime with one care professional on the first day of the inspection visiting residents with them with the resident’s permission. They said they came in twice a week and found staff very helpful and mentioned on senior member of staff in particular. The manager returned a standard form, the Annual Quality Assurance Assessment (AQAA), to CSCI and this was taken into consideration. He contacted us shortly after coming into post and has kept us informed of the progress within the home and what he hoped to achieve in the short and long term. The inspection also involved the case tracking of nine people’s care, the assessment of a range of the home’s records, procedures and forms as well as observation and a tour of the premises. What the service does well: The home continues to offer comprehensive support to residents using a variety of specialised services through a range of professionals such as psychiatrists, nutrition specialists and speech therapists ensuring all the needs of residents are met. They are giving individualised care and delivering it in a flexible and personable manner that suits individual needs where possible. There is a comprehensive induction programme in place for new staff and a comprehensive training program for both trained nurses and care staff. There is ongoing training and development as well themed supervision on working practices as part of supervision that has resulted in improved standards of care and the promotion of good care practices. Residents care plans are reviewed on a regular basis and generally health care needs are well met. Staff ensure the privacy and dignity of residents is maintained and residents are supported to exercise choice and control over their own lives as much as possible. Residents are encouraged to maintain Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 7 contact with relatives and friends and staff encourage them to keep in contact where possible. The home has a good range of activities including regular exercise to keep residents stimulated and to ensure they are able to socially interact with others in and away from the home. The home provides a varied menu that offers a choice of meals and specific preferences and cultural needs are catered for and continually monitor the menu to make sure it is what the residents want and need. The home ensures residents are well protected with an effective complaints policy and procedure in place that is accessible to residents. It ensures that all staff are trained and informed about adult abuse. They have effective policies and procedures in place around adult protection and follow policies and procedures when the need arises. What has improved since the last inspection? What they could do better: The home could be better at making sure residents have access to consultations with physiotherapists who can review their programs of specialist care and keep them up to date to meet their needs. This could be done by employing a physiotherapist on a part time basis to ensure all residents who need an up to date physiotherapy assessment and program have this done. Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 8 All staff need to be made more aware of their responsibilities around what they need to report and record around verbal complaints and incidents as well as keeping managers informed of all complaints and incidents. Staff need to develop and broaden their communication and writing skills to enable them to communicate clearly and effectively both verbally and in writing when dealing with residents, families and other professionals. Staff need to be more aware and have understanding of all types of disabilities and conditions that the residents of the home have and how staff and the general public can misinterpret this. This could done by appropriate training to raise awareness and understanding of different stages of different conditions. The activities co-ordinators need to develop activities that are of interest to residents who are in the younger age bracket and those who need more one to one interaction. The home needs to reassess residents and audit and review each units equipment in conjunction with moving and handling needs at the same time it reviews the physiotherapy needs of the residents to ensure there is enough equipment available to enable staff to meet the resident’s needs within a reasonable time frame. 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. Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 9 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 Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 10 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): 1,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service users’ guide are good at providing prospective residents with details of the service the home provides. Assessment information set out clearly the needs of the residents using the service. Staff know residents well and they use this knowledge as well as the assessment information to work with people to best need their needs. EVIDENCE: We checked the statement of purpose and the resident and relatives information pack that is given to residents and their families when they come to visit the home to help them decide if the home can meet their needs. The manager said these are regularly checked and updated to reflect the changes Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 11 in the home and the organisation that runs the service and had been up dated when the new manager came into post at the beginning of November 2007. When they come to live in the home they are given a copy of the resident and relatives information handbook that records their room number, which unit they are in, their named nurse and named key worker, which is for them to keep in their room. We were told a copy of the care assessment would be faxed to the home and where possible the prospective resident and /or their family would visit the home to see if it was suitable. The manager would visit the resident and a full needs assessment would be completed to ensure the home could meet the prospective residents needs before a place in the home was offered. On the first day of the inspection, we met a prospective resident, their care manager and a friend, who had come to look around before deciding if they wanted to live there. While they were waiting they were given information about the home that they could take away to read. The manager said he had two appointments booked that day to assess prospective residents to see if they were able to meet their needs. If he thought the home was suitable for them, they would be invited to come to look around. Case tracking was used to evaluate the care arrangements for five residents on the ground floor and five residents on the first floor and one in the palliative care unit. Two of the assessments viewed were for two recently admitted residents. The information recorded in both assessments show how consideration is given to all areas of both health and social care needs. Copies of care management assessments are held for both residents. This assists staff get a full picture of why referrals were made for nursing care. As well as pre admission needs assessments there are also medical reports from health professionals giving information on diagnosis and the medical and nursing treatment prescribed, this also includes pain control measures. Records of communication with the palliative care team prior to admission and since were seen. It is evident that this team does regular monitoring visits to palliative care residents. From the information gained in the assessment the home is able to make preparations for the admission of new residents and can make sure that all the necessary equipment and supplies were in place in time for their admission. Intermediate care is not provided and therefore standard six was not assessed. Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning has continued to improve with systems in place to ensure that this improvement continues. Residents find that healthcare is promoted but the home needs to have a more robust system in place to ensure consultations that are felt to be necessary by the resident and their families with professionals happen and are not missed. Residents feel they are treated with respect and their right to privacy is upheld. The pharmacy inspector attended the home as part of the inspection and will send a separate report. EVIDENCE: Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 13 The home is using a system called QUEST, which is an assessment tool with mandatory fields in the principles of care planning that is used in all BUPA homes. Individual care plans are developed from the individual needs assessment to make sure the health and personal care needs of residents are met. On admission all residents are weighed and within six hours of admission a range of risk assessments including Waterlow scores are completed. Eleven care plans were examined during the three days of the inspection. The care plans are clear and set out all the support, assistance and needs of each resident. BUPA assessments for activities of daily living include standard statements, which have a number rating. Included within this documentation are mandatory care plans for nutrition, falls and manual handling. In the files inspected these were completed. We found that in general care plans contain good information in the intervention section, this provides staff with a good foundation and guidance to give the care required. The care plans are relevant to current areas of identified need and include supporting documentation such as risk assessments. Issues such as sleeping and end of life were covered in the documentation. One care plan of a new resident included a map of their life and a personal plan. Staff said, “They are getting to know his little ways”. Risk management strategies are agreed following risk assessments. Attention is given to assessing the need for use of cot sides and the agreements we saw were signed to indicate consent by either residents or relatives/ representatives. Continence assessments are completed for residents on admission and regularly reviewed thereafter. Manual handling assessments, weight records and pressure sore risks are kept updated and demonstrate that that these are kept under review. There are lifestyles profiles included which provided valuable information about the residents past life, personal preferences. There is a record of the personal support for their physio and a risk management of this support. We observed the exercise assistant working with two residents. One resident and their relative we spoke to said they had not seen a physiotherapist since September 2006. They said they wanted to discuss their options with a professional physiotherapist and if there was anything else that could be done to help them improve / maintain their independence. When we checked their records we found it their physiotherapy had not been reviewed since that date. We spoke to the exercise assistant who works in the home assisting residents with their physio. He said he follows the program set by a professional physiotherapist for residents. When we checked the list of residents he sees and checked the records of when they were last seen by a physiotherapist. We found that they were seen and given a program when they first came in to the home but they had not been seen by a physiotherapist to review their progress since they were first assessed. The exercise assistant had continued to follow the initial program, which, in some cases where two years old and had not been reviewed in that time. He showed us records he completes each time he Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 14 sees a resident. The residents we saw him working with said he does a good job. We noted not only is he helping residents through their physio program to keep mobile but also at the same time he is giving them one to one attention. The physio programs need to be reviewed at regular and needs to be reviewed. We recommend the home employ a physiotherapist to assess all the present residents programs and make sure the programs are relevant and up to date. Daily records maintained provide evidence of the care delivered both during the day and night time. When we looked at the records we could see health care is promoted. The records relating to health care indicated input from the GP and the multidisciplinary team and records are kept of the results of daily blood sugar tests. We spoke to the GP who said he came once a week or more often if it was necessary. He was very positive about the care the home was giving. There were reports on the outcomes of CPA meetings. There are indications of positive outcomes for residents. The residents and their relatives apart from one, who said they were happy with the care most of the time and the staff were good, while all others spoke positively of their experiences. Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home needs to offer a broader range of activities to interest all the age groups and disabilities of the residents. Residents are encouraged to maintain contact with family and friends. Residents are generally supported to exercise control and choice over their lives. Residents receive a varied and balanced diet and are supported in a sensitive manner to choose and eat food they like. EVIDENCE: We spoke to five relatives during the inspection. Visitors came and went throughout the day without restriction. They spoke positively about the care given to residents. One relative said, “The staff are good”. Three relatives said they come daily and found the staff very caring and one relative said, “I come Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 16 here daily, I see the good work done by staff, it is a pleasant and friendly home to come to”. A relative who had spoken to us at the last inspection said, “they were still happy and pleased with the home”. The home has employed a new activities coordinator who is a member of staff who worked in the home for several years as a support worker before taking up the post as the activities coordinator. This means they know the residents well and are able to. The activities room is well equipped but activities take place in all parts of the home depending on what type of activity it is. We spoke to several residents who said they loved going there and enjoyed all the activities put on by the activities staff. Each resident has an activities folder with a written record of their interests and what they have attended. We saw a number of activities had been planned and information about these was on the notice board advertising them. Staff were seen encouraging residents to take part in a number of these activities. On the first day of the inspection there was a screening of a DVD that had been taken of a recent event and as many residents and their relatives as possible had come into the lounge to see it. We were told residents and their relatives could buy a copy of the DVD for a nominal price and any profit would be put into the residents activities fund. Staff were also seen engaging with residents who were unable to leave their rooms or did not want to join the larger group, in one to one sessions, such as reading the newspaper to them or chatting. Two residents told us they attended outside activities and they had transport arranged to take them there. A new resident, who is a young adult, has an advocate, who contacted us. They said they could come and go as they pleased. They felt from what they had seen in the home, there was not enough stimulation or the right type of activities for someone of their clients abilities to take part in and questioned whether this was the place for the person they advocated for. They felt some of the statements were ambiguous, such as “the resident had fully taken part in a cookery session”. They said their person would not be able to fully take part because “they would not be able to hold or be able to coordinate the utensils”. We were told a social worker that one resident they see said he likes going out everyday because whenever he is indoors he feels depressed. They made the comment “Most of the residents at Manley Court are over 60-years of age and this is why most of the activities arranged by staff are geared toward them”. They stated that they feel better when they goes out to visit his family or do window-shopping because such activities lift their mood. The nutritional needs of residents are regularly monitored from time of admission. Those residents at risk due to poor nutrition are identified and their conditions monitored closely. Appropriate action is taken as required if there is a weight loss. This was evident from the records held for a resident recently admitted. Appropriate referrals were made to relevant health professionals to seek advice on how to promote the resident’s health further. Food supplements are supplied to those who are not eating well or who have difficulty eating through swallowing problems. We saw that one resident whose care plan said they needed a “soft diet “ was given an ordinary meal. When we checked the Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 17 meals list we found there was no record on this that they needed a “soft diet” so it was a mistake that could easily be made by a member of staff who did not know the resident well. This was pointed out to the person in charge and the manager and we were told they would amend the meals list to include this information. We joined the residents for their lunch on the first day of the inspection and observed the residents enjoying their meals. We noticed the practice of one member of staff assisting two residents to eat at the same time has stopped and there was enough cutlery for residents to use without it having to be washed between courses. Staff were seen assisting and supporting residents to eat and this was being done in a sensitive way. Two relatives said they always come and assist their relative to eat. We were told the home now had “protected meals times” where no medication is dispensed during meal times and all available staff assists in serving meals and support residents who need help to eat. Although one resident’s family said “the person in charge usually gives out medication at lunch time but they didn’t today”. A number of residents and their relatives spoke positively of meals served, “ The food is generally good and very tasty” were comments received. Comments in the surveys returned to us were generally positive. We spoke to the cook and the domestic supervisor who come around after lunch to see what residents thought about the meal. We saw copies of the menu displayed on the wall of each unit and observed members of staff going around asking residents who could not see the menu what they would like to eat. The supervisor said the home has a varied menu. They use what is called the “BUPA Menu Master” that helps them to ensure the menu meets the nutritional needs of the residents and adapt this to develop a menu that the residents like and meets their cultural tastes. Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 18 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their families are given information on how to complain to the home and to independent bodies. Their complaints are taken seriously and investigated fully. Complaints within the home are handled properly and residents feel confident that their concerns will be listened to. Records of complaints investigations indicate they are taken seriously and are acted upon. Residents are protected from abuse. EVIDENCE: We were told the company has a clearly defined complaints policy with agreed timescales for managing complaints. All residents are issued with an information pack that is placed in their rooms. This includes a copy of the home’s complaint policy and procedure and information about advocacy services. The information that accompanies the policy is prominently displayed in the home. The policy includes a three-tier framework including the home, the regional management team and the national Quality and Compliance department. BUPA Care Homes has appointed a Director of Quality and Compliance and has developed a national Quality and Compliance team of experts. Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 19 BUPA Care Homes has robust policies for dealing with allegations of abuse or neglect. Staff cannot only raise concern within the home they have access to senior staff outside the home. There are well-documented procedures for reporting under POVA should the need arise. The manager sends reports of all complaints received by the home to CSCI and liaises with the appropriate professionals, which demonstrate that detailed investigations are always conducted and appropriate action is taken. We were shown the complaints and complements book. This records the complaint the action taken and the outcome. Since the last inspection in October 2007 the home has had nine complaints, all of which have been resolved within 28 days and three complements. One resident’s family said they were not happy about a number of things which we discussed and in particular they said they had complained about an incident that had happened recently and they felt it had not been addressed. When we checked we found this had not been reported to the manager. We discussed this and a number of other issues the family were not happy about. The manager immediately dealt with main issue and had a meeting with the family. When we retuned on the second day of the inspection we fed back information about the other issues to the family and they were much happier. We found from speaking to relatives and two professionals who said staff do not always record relevant incidents or report them to the management of the home to follow up. Staff must record and report all complaints by following the organisations complaints policy. In respect to adult protection the home has a robust policy and procedure. The whistle blowing policy is included in the staff handbook as well as an employee guide regarding the Protection of Vulnerable Adults (POVA) list to which referrals of staff implicated in abuse of residents are made to prevent them from continuing to work with vulnerable adults. Employee responsibilities to report abuse are also addressed in the handbook. We were told adult protection training was part of the staff induction training and they have POVA awareness courses annually. We were told POVA is discussed at residents and staff meetings as well as it being discussed in supervision. The manager said “keeping residents safe is given very high priority and there is no room for complacency any allegation is treated very seriously”. Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 20 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): 19,20,21,22,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe environment that is generally well maintained but some areas are shabby and some repairs and renewals need to be carried out. There needs to be adequate equipment available to enable staff meet the residents needs within an acceptable time frame. Infection control has improved but staff needs to be aware they are all responsible for robust infection control. EVIDENCE: The home is purpose built and offers single en –suite accommodation with adequate personal and communal space. The home is divided into five separate units. There is a lounge and dining area on each unit and these are Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 21 being refurbished. As we inspected the home we noticed the home has purchased new dining tables and chairs for the dining rooms and these were attractively set at meal times. We were told the home had new cutlery following the complaint during the previous inspection and there appeared to be enough cutlery for all the residents without it having to be washed between courses. The entrance hall was comfortably furnished with two new settees. There were a number of seats in the corridors that have been attractively recovered, where residents can rest as they walk around or an alternative sitting area to meet with their relatives. One bathroom had just been refurbished and a ceiling hoist had been installed. On the first day of the inspection the representative of the company who supplied the hoist had come in to demonstrate to the staff how it should be used. We checked a number of shower rooms and noted some of the shower trays and enclosures were shabby and looked unhygienic and questioned, “ Would we want to use them?” We noted a toilet cistern in one of the shower rooms was broken and needed to be replaced, as it looked unsightly as well as being a health and safety hazard. Many of the resident’s bedrooms have been personalised with pictures, photos and small items of furniture, but some of the homes furniture still needs to be replaced. Such as a broken bed table which we saw in an empty bedroom that could be a health and safety hazard. The manager said they have redecorated one unit, improved on the homes security system and lighting. When bedroom becomes vacant it is refurbished and redecorated in readiness of a new resident. We were told the home is supported in maintaining the environment by a central team of experts within BUPA Care Homes. They have a specialist property and estates department as well as a hotel services department. The in house maintenance man decorates the bedrooms as they become vacant as well as undertaking the ongoing daily maintenance. At the last inspection in October 2007 we were told BUPA had allocated money to buy identified pieces of furniture and redecorate areas of the home. This is ongoing at the time of the inspection. We saw each unit had a number of different types of hoists and assisted bathing facilities. Each unit has two standing hoists and two other types of hoist that were used with slings. One resident and their family said they felt two standing hoists for the number of residents who needed to use them was not enough. They said they sometimes had to wait what they felt “was an unacceptable time until it becomes free”. There are enclosed gardens at the rear of the premises that slope away from the home which the manager and staff had has concerns about. The manager had told us on the first day of the inspection the organisations health and safety office had arranged to visit the home the day before we were due to return for a second day of the inspection. On the second day of the inspection the manager told us the visit had gone well. He said the areas of concern that he had highlighted had been agreed and would be addressed, such as the slope in the garden that is causing concern. This is to be levelled for the safety Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 22 of the residents using the garden and the garden was to be made more accessible. The workstations that were causing concern because they had sharp edges were to be replaced. We found the home was generally clean and hygienic and there were no unpleasant smells on the days the inspection took place. One resident’s advocate, who contacted us after the inspection, said there were times when they had noticed there were unpleasant smells on one unit. The home has robust policies and procedures around infection control and staff receive training around infection control as part of their induction. On the first day of the inspection all bathrooms were clear of equipment but noted on the second day equipment was again being stored in bathrooms. On the first day of the inspection we had to ask the cleaner to empty a bin that was over flowing in one bathroom. All staff need to be observant and aware that it is everyone’s responsibility to ensure prevention and infection control is complied with at all times. Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 23 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new organisation has robust recruitment procedures to protect and keep the residents safe. Staff files have been audited and shortfalls have been addressed following the policies and procedures Bupa have in place. Staff are trained and competent to do their jobs but they need to broaden staff training to include training to raise awareness and understanding of differing types of disabilities and conditions that some residents of the home have. The organisation needs to address the shortfalls in some of the staff who have poor written and verbal communication skills. EVIDENCE: Three of the ten staff files were of new staff recruited since the last inspection in October 2007. We spoke to two of the new staff who told us about their experience of their recruitment and the types of experiences they had had as part of their induction into the service and they felt they had been well inducted and supported during this time. We were told all staff recruited in the past twelve months has been vetted fully before they commence employment and followed the BUPA recruitment procedure. Enhanced disclosures with POVA checks, previous employment records and references were available for three new staff. Three of the staff are registered nurses. The majority of staff have Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 24 worked at the home for some time. We were told all staff files have been audited that was made as a requirement at the previous inspection in October 2008 by the administration team. The administrator went through the system with us. All staff files have a checklist at the front of each file to ensure all information needed is there and has been checked. They had systematically audited all the staff files. They followed up any short falls by asking staff to supply any missing data, such as gaps in employment history and in references and current immigration status. All staff had CRB with Enhanced disclosures. The home is following good practice and is up dating CRBs if any staff has CRBs over three years old. The manager said all staff have individual induction booklets that records their induction. The qualified nurses have been issued with a “Qualified Nurse Learning Portfolio” that is given to all BUPA trained staff. This incorporates BUPA induction, ongoing training records and supervision records. We spoke to twenty staff during the course of the inspection who had different roles in the home. . This included the home manager, unit managers, trained nursing staff, care staff, catering and domestic staff, the maintenance man, clerical and adminstive staff as well as the activities staff. This gave us a broad spectrum of staff views of the home. All staff were positive about the home. We were given a copy of the training plan for 2008. Staff told us about the range of training they had undertaken. This included having regular updates in mandatory topics, such as moving and handling, fire training and health and safety. They said they had recently had training in adult protection and food hygiene, meeting the nutritional needs of residents and end of life care with the palliative care nurse specialist. This promotes the Gold Standard Framework. Throughout the inspection we observed staff treating residents well, with dignity, respect and kindness apart from one occasion when we observed a member of staff assisting a resident with a learning disability to have a drink. They did not seem to understand why a resident was distressed when they took the cup away thinking the resident had finished and walked away. We spoke to the key worker about the incident who said they would speak to the member of staff. One professional contacted us as part of the ongoing inspection, who also raised concerns about a lack of understanding on the part of some staff within the home of people who have a learning disability. Another professional who spoke to us said one resident they work with said “they wish that people would be educated about Parkinson’s disease and its symptoms so that they would not feel that they are faking their freezing episodes or their illness”. They said they were referring to members of the public as well as staff. We spoke to the manager about these incidents / remarks. The home could broaden their staff training to include some awareness training on communicating with residents who are unable to communicate through speech and how symptoms of other types of disease such as Parkinson’s disease can Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 25 affect residents behaviour and how this can affect residents perceived behaviour. Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 26 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): 31,33,34,35,36,38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents live in a home that is in the process of developing their management and staff team to ensure the home is well run and in the best interests of the residents, which continues to be promoted. Supervision has been reinstated and has improved to support staff in their professional and personal development. Working practices and associated records ensure that the resident’s finances and health and safety are safe guarded. EVIDENCE: Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 27 Since the previous registered manager left February 2007 and the deputy manager left shortly after that home has experienced a number of changes of management. The organisations management arrangements did not give the home the consistency it needed. The acting manager had the sole responsibility for management without the support of a deputy manager. The organisation has now appointed a new manager who took up the post in November 2007. The manager told us that he has appointed a deputy manager who was due to take up their post in June 2008. He said he hoped this would give stability to the home and was looking forward to developing an excellent quality service for the residents working with the help of the deputy manager and staff team. The manager needs to make an application to become the registered manager and this will help give further stability and direction in the home. The manager said the relatives meeting he had organised had not been well attended but the relatives and residents that were there had voiced their opinion about the home. He said he would try to have the next meeting at a different time in the hope this would encourage relatives to come. One resident and their family said they did not think it was appropriate that staff had attended the meeting. They said they thought residents and families would speak more freely if staff were not at the meeting. Most relatives we spoke to during the inspection told us they felt they could speak to the manager about any concerns they had and they would be listened to. Only resident and their family said they had tried to speak to the manager but they felt they were not listened to. This information was passed back to the manager. On the second day of the inspection the relatives said the manager had come to speak to them about their concerns. The majority of residents and relatives we spoke to during the inspection said they had confidence in the management. They said they felt the care in the home was improving. The organisation has appointed a Director of Quality and Compliance and has developed a national Quality and Compliance team of experts and the organisation conducts regular regulation 26 visits, which are recorded. They have devised a Quality Improvement log that all Bupa managers are required to complete during the feed of the inspection to help the organisation develop early improvement plans. Staff continued to say they felt supported by the homes immediate management but would like more from the organisation, such as free lunches and more money for working weekends. We spent time speaking to the administrator who has responsibility for administrating the resident’s money and helps the residents administer their finances. To protect the resident the home will only manage their money if they sign the Financial Agreement and they have policies and procedures in place that staff at the home follow. We went through the financial system with the administrator who explained how it was administered. Records are kept on Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 28 the homes IT system and four residents finances were checked and correct. Full details of the system used by the home have not been disclosed in this report for security reasons. The manager said the staff had regular supervision that was recorded and kept on file. He said the home had a different supervision theme every month. One month the theme was infection control, the next it was dementia care. Staff and their manager signed the supervision records we saw. The manager told us he encouraged staff development and this would be discussed in supervision. We were shown the records and spoke to the maintenance man who has the responsibility for carrying out many of the health and safety measures and servicing of the equipment and we found these were well kept. The home has robust policies and procedures around health and safety. Fire safety records evidenced that fire alarm call points are carried out weekly. Regular fire drills are now taking place at different times to ensure all staff is familiar with the process. Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 29 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 3 X 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 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 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 X 3 Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 30 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 12(1) Requirement The registered person must ensure residents have access to consultations with physiotherapists who can review their programs of specialist care and keep them up to date. The registered person must ensure all staff are aware they must follow the organisations complaints procedure if any complaint is made to them. The registered person must broaden staff training to include appropriate training to raise awareness and understanding of all types of disabilities and conditions that the residents of the home have and to meet the residents changing needs. The registered person must ensure staff develop and broaden their communication and writing skills to enable them to communicate clearly and effectively both verbally and in writing when dealing with residents, other professionals and keeping records within the home. DS0000006997.V363356.R01.S.doc Timescale for action 30/08/08 2 OP17 Sch4. 11 30/08/08 3 OP30 18 (c) (i) 30/08/08 4 OP30 Sch 3. 18 (c) 30/08/08 Manley Court Nursing Home Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The registered person could employ a physiotherapist on a part time basis to ensure all residents who need an up to date physiotherapy assessment and program have this done to meet their needs. The registered person should ensure that the activities coordinators develop activities for residents who need more one to one interaction. The registered person should ensure that the activities coordinators develop activities that are of interest to residents who are in the younger age bracket. The registered person should ensure there is enough equipment available to enable staff to meet the resident’s needs within a reasonable time frame. The Registered Person should continue to encourage staff to follow good practice and have protected meal times. 2 3 4 5 OP12 OP12 OP22 OP15 Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Manley Court Nursing Home DS0000006997.V363356.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!