Inspection on 21/11/06 for Manor Barn Nursing Home

This inspection was carried out on 21st November 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

Manor Barn Nursing Home 03/03/08

Manor Barn Nursing Home 17/09/07

Manor Barn Nursing Home 20/04/07

Manor Barn Nursing Home 25/10/05

Manor Barn Nursing Home 03/05/05

Manor Barn Nursing Home 08/02/05

Manor Barn Nursing Home 14/05/04

Manor Barn Nursing Home 11/02/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Manor Barn Nursing Home Appledram Lane South Fishbourne Chichester West Sussex P020 7PE Lead Inspector Mr E McLeod Key Unannounced 21st November 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 Manor Barn Nursing Home DS0000024175.V314727.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. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor Barn Nursing Home Address Appledram Lane South Fishbourne Chichester West Sussex P020 7PE 01243 781490 01243 813713 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) Rhymecare Limited Post vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (5), Physical disability of places over 65 years of age (5) Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Five service users in the category Physical Disability (PD) aged fifty years and over may be accommodated. Five service users in the category Physical Disability Elderly (PD)(E) aged over 65 years. A total of 30 service users may be accommodated at any one time. Date of last inspection 25th October 2005 Brief Description of the Service: Manor Barn is a care establishment that provides nursing care, and is registered to accommodate up to 30 residents in the category of old age, not falling within any other category. Manor Barn was originally constructed in the sixteenth century, since then it has been extended and converted. The home is situated near the village of Fishbourne. The service is operated by Rhymecare Ltd. the service at present. There is no registered manager for Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection visit was arranged to follow up requirements made at the previous inspection, and to assess the home’s performance against the key national minimum standards for care homes for older people. The inspection was planned taking into account written pre-inspection information received from the provider, some of which has been included in the evidence given in this report. It was also planned taking into account information received from the social and caring services department of West Sussex County Council in relation to two adult protection referrals, and a complaint received from a member of staff at Manor Barn. The inspector interviewed four residents, four relatives and one visiting professional. Two senior members of the staff team were interviewed, including the acting manager. A partial tour of the premises was made. Four sets of care plans and admission records were sampled. Two sets of staff recruitment records and documents relating to staff training were sampled. Some policies and procedures, for example on medication and on the protection of vulnerable adults, were sampled. What the service does well: Most staff are seen by residents and relatives as helpful and supportive. The premises are decorated and furnished to a good standard, and the garden and grounds are well maintained. A good standard of bedroom and bathroom accommodation are being provided. Some activities are being provided for residents, and private practitioners such as an aroma therapist visit the home. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The provider must ensure that each resident receives a contract or terms and conditions of residence, which advises them of their rights and responsibilities, and who pays what part of the fee and when. For the safety of residents, arrangements should be made whereby a photograph of the resident to receive the medication is checked before the medication is given. The care of residents would be improved by involving residents and their relatives being involved in drawing up and reviewing the care plan, and by the resident or, where more appropriate, their relative receiving a copy of the care plan. The key work system is not ensuring that residents feel there is an allocated member of staff who is taking a particular interest in their care and needs. The provider needs to ensure that infection control policies and procedures and staff implementation of them reflect current good practice. Two vulnerable residents were not receiving the assistance they needed with eating, leading to food going cold before it is eaten. Three residents are not receiving the assistance they need to enable them to go for walks. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 7 The inspector felt that more could be done to make meal times a more sociable occasion for residents. Some staff are following routines at the expense of residents’ choice, for example residents being put to bed before they are ready for this. Some complaints made to the home are not being recorded or investigated. It is important for the better safety and protection of residents that training in local adult protection procedures is made available to relevant staff. Call bells and calls for assistance from residents are taking too long to answer. A minority of staff are seen as having an abrupt and bossy manner which on occasions is causing distress to residents. The provider must ensure that recruitment of staff documentation protects residents. The provider must comply with requirements made during the environment health department inspection of 10th July 2006. Regular, recorded environmental safety assessments must be undertaken, and action taken to minimise safety hazards. For the support and professional development of staff employed, and the care and safety of residents, formal supervision of staff should be provided. A registered manager who is appropriately experienced and qualified in the management of care homes must be appointed. 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. Manor Barn Nursing Home DS0000024175.V314727.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 Manor Barn Nursing Home DS0000024175.V314727.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP1, OP2, OP3, OP6 The quality of outcomes for residents in this section is good. The judgement has been made using available evidence, including a visit to the service. Each resident has a copy of the service user guide, which gives information on the service provided. The provider must ensure that each resident receives a contract or terms and conditions of service which includes the information recommended in standard 2.2 of the National Minimum Standards (NMS) for care homes for older people. People referred do not move into the service without having had their needs assessed by staff in their home environment or in hospital. Judgement - The home does not provide specialist intermediate care. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 10 EVIDENCE: The fees are £500 to £700 per week. Four sets of admission records were sampled, which indicated that an assessment of the resident’s needs by a qualified member of staff are being arranged before admission. One resident interviewed said his daughter had found the placement and there had been a visit before he moved in. Three of the residents interviewed had a copy of the service user guide in their bedroom, which gives information on the service provided for residents and prospective residents. A sample copy of the contract or terms and conditions of residence is included in the service user guide. However, a resident also should receive a contract or terms and conditions of residence which includes information on the rooms to be occupied, services covered by the fee, fee payable and by whom, rights and responsibilities, and terms and conditions of occupancy including period of notice. None of the residents interviewed were aware if they had a placement contract or terms and conditions of residence. Of the relatives interviewed, two said they were not aware of a contract/terms and conditions of residence, and one said this had been received. The inspector requested to see copies of the residents’ contract/terms of residence, but no contract specific to an individual resident was available, and were not present on any of the four sets of care records seen. The home does not provide specialist intermediate care. Manor Barn Nursing Home DS0000024175.V314727.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP7, OP8, OP9, OP10 The quality of outcomes for residents in this section is poor. The judgement has been made using available evidence, including a visit to the service. The service users health and personal and social care needs are not all being included in an individual plan of care. Service users health care needs are not fully met – some residents are not being assisted to access some of the health care support they are in need of. No service users are responsible for their medication. Service users are not always protected by the homes’ policies and procedures for medication. Service users are not always treated with respect. The resident’s right to privacy is being upheld. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 12 EVIDENCE: Pre inspection information received from the provider indicates that residents have high levels of care needs. For example, sixteen residents were said to be doubly incontinent, nine residents were said to need prompts or help with meals, and nineteen residents were said to use a wheelchair. A copy of the home’s policy for the administration of medicines dated 27.5.05 was seen, and part of the medication round was observed. The provider should consider whether a photograph of the resident accompanying the medicine records would reduce the possibility of the wrong resident receiving the wrong medication. There was no evidence on the four sets of care plans sampled that the care plan was agreed or subsequently reviewed with the resident or their relative. One resident interviewed said he had not been asked how he wished his personal care to be provided, and he found that different carers were providing his personal care in different ways. Relatives interviewed said they had not been included in formulating the care plan or in care plan reviews, although some of the relatives interviewed were regular visitors to the home and wished to contribute to the planning of the resident’s care. One relative said that “mum has a bath once per week, but would like baths more often”. The inspector suggests that involving residents and carers more in the care planning process would allow such views to become known to staff, and improve the planning and delivery of the individual resident’s care. One relative said that around a month previously she had gone to the home at quarter to one in the afternoon and found her relative still to be in bed, to be very wet, and the sheets and duvet cover to be wet. She said a member of staff apologised about the wetness and the lateness in assisting the resident out of bed. The relative said about a week ago she found the bed had been made with the duvet cover still wet. None of the residents interviewed knew who their key carer was. Some residents were aware that the name of the key carer was recorded on their copy of the service user guide, but it was not their experience that an Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 13 individual member of staff was checking with them to see if their care needs were being met or who could arrange little things for them such as purchases. While residents felt that they received good care from the majority of staff in the home, one resident said that “for some you’re just a number”. Staff interviewed said residents and relatives didn’t have a copy of the care plan, and were not usually involved in reviews of the care plan. Interviews with residents and relatives indicated they would like to be involved in preparing the care plan and reviewing the care plan. Three relatives interviewed said that the home had failed to sort out their resident relative’s hearing aid problems, and that the relatives felt it was left to them to make arrangements themselves. One resident interviewed has MRSA in a wound detected in October 2006, and he told the inspector that he believes the MRSA was transferred to the wound by staff in the home during the course of their duties. The resident’s care plan was seen to include a strategy for minimising the risk of this infection spreading further. Manor Barn Nursing Home DS0000024175.V314727.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP12, OP13, OP14, OP15 The quality of outcomes for residents in this section is poor. The judgement has been made using available evidence, including a visit to the service. Services users do not find that the lifestyle experienced in the home matches their expectations and preferences and satisfies their social and cultural, religious and recreational interests and needs. Service users maintain contact with family, friends and representatives and the local community as they wish. Service users are not helped to exercise choice and control over their lives. Service users are receiving a balanced diet, and most residents are choosing to eat in their bedrooms. Some residents are not receiving the assistance with eating their meals which they require. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 15 EVIDENCE: A catering management service has now taken over providing meals, the advantages of which were seen as care staff no longer having to undertake kitchen duties. Residents interviewed who had their meals in their rooms were saying clearly that this was their choice, and that menu cards were brought round the day before to see what meals they wished to order. The dining area had chairs for only about six residents, and on the day of the inspection only one resident was seated at the table for lunch. Other residents were eating in the sitting room and conservatory in their chairs, or in their bedrooms. It was the observation of the inspector during lunch that some residents were not receiving the support they needed with meals, and two residents in the sitting room were seen to be struggling with their meal. One was unable to reach the dessert set down before her, and the other struggled for twenty minutes with her main meal even when after ten minutes the inspector had alerted staff to the need for the resident to be assisted. Two relatives of residents were present who were giving full assistance to their relative with their meal. However, for long periods during lunch, there were no staff available in the sitting room/dining room to assist residents with eating or other support. The inspector notes that in many care homes visited residents look forward to meal times as a social occasion, and suggests that the provider consider if there are ways in which meal times could be made more communal for residents who wish this. Interviews with residents indicated some are not often coming out of their bedrooms, but there were indications that with staff assistance they would like to do this. For example, three residents interviewed said that they would like staff to assist them going for short walks, in wheelchairs if needed, due to their mobility or orientation problems. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 16 Discussions with staff indicated that walks with residents were usually only available if there were student nurses assigned to the home, due to staff having limited time. On the afternoon of the inspection, a quiz was being done in the sitting room which was attended by a few of the residents. One resident interviewed had received an aromatherapy treatment on the day of the inspection, and the aroma therapist advised the inspector she visits about eight residents in the home once a week to provide aromatherapy, which they paid for privately. Discussion with relatives indicated that residents are not always being offered choice in such matters as what times they go to bed, and when and how often they wish to bathe. There is a rota for bathing, seen by the inspector, which indicated that each resident is allocated a particular day per week for a bath or shower. One relative interviewed said her mother would like to have more than one bath per week. One relative interviewed said that she had seen one carer putting residents to bed from 3 p.m. The relative said on one occasion when the member of staff had been doing this a resident told her “I haven’t finished my tea yet”. The inspector discussed this with the deputy manager, who agreed that sometimes residents were being put to bed too early, and that she had reminded staff that they should stick to the guidelines for the individual resident set out in the care plan. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 17 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): 16, 18 The quality of outcomes for residents in this section is poor. The judgement has been made using available evidence, including a visit to the service. Service users and their relatives and friends are not confident that their complaints will be listened to. Service users are not being protected from abuse. EVIDENCE: The home’s complaints record was seen to include one complaint since the previous inspection. However, one resident interviewed said he had been assisted by a relative to make a complaint in April 2006, but although a written reply to the complaint had been received, the complaint was not included in the home’s complaints record. The inspector also considered that the two complaints made by a relative about wet bedding within the past month and the failure to assist a resident out of bed until the afternoon, should have been logged and investigated as Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 18 complaints. The relative concerned said she did not have confidence that such an incident would not happen again. In information sent to the Commission previous to the inspection, the provider advised that “we do not get involved in any (resident’s) financial matters, this is company policy”. A copy of the updated adult protection policy was seen, which provides guidance to staff on what action should be taken in the event of an adult protection incident. The previous requirement concerning this is now assessed as met. However, there are at present investigations being undertaken by West Sussex County Council (WSSC) social and caring services department into two incidents seen as adult protection matters. WSCC social and caring services have advised the Commission that they consider there was an unreasonable delay in one of the matters being reported to them. Interviews with the deputy manager and senior nurse on duty indicated that although they have received basic adult protection training, neither of them had received training in local adult protection procedures (which have recently been available to care home staff). The inspector considered that such training would assist senior staff in the home in the handling of adult protection incidents. Allegations concerning care practice were received by the Commission on 20.11.06, and these have been referred on to West Sussex County Council as possible incidents of abuse. The inspector advised the deputy manager that some of the information that had been gathered during the inspection would also be referred as possible incidents of abuse to West Sussex County Council’s social services department. Relatives and residents gave examples of how the behaviour of staff was at times causing distress to residents. The provider must ensure that such incidents are investigated and appropriately acted upon. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 19 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, 24, 26 The quality of outcomes for residents in this section is good. The judgement has been made using available evidence, including a visit to the service. Service users generally live in a safe, well maintained environment, although three hazards in bedrooms were identified during the visit. Service users live in comfortable bedrooms with their own possessions around them. Service users’ bedrooms are not always safe. The home is clean, pleasant and hygienic. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home is generally well maintained. The inspector noted hazards in three bedrooms visited. In room 2 there were electric wires from six separate appliances crossing the floor of the room. Staff interviewed said they were aware of this, but didn’t know what to do about it. One relative interviewed said that the wash hand basin in the resident’s room was in need of fixing. In a third bedroom stacked boxes of books were seen as a trip and accident hazard. It is a previous requirement that the home provide locks on all bedroom doors, as this is considered important to a resident’s privacy and dignity. The provider has advised that all bedroom doors now are fitted with locks, with the exception of bedroom 17 which includes a fire exit. Decoration, furniture and accommodation seen were of a good standard. However, in one bedroom visited a resident had boxes of books stacked across part of the bedroom the corner. The resident concerned has serious mobility problems, and this method of storage could be hazardous. The inspector considers that as there was room for more shelving in the bedroom that the resident could be offered more shelving. The grounds and gardens are being well maintained. One resident interviewed said the cleaning was “reasonable but rushed at times” due to there being “not enough staff”. However, all areas of the home visited were found to be clean and hygienic. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 21 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): OP27, OP29, OP29, OP30 The quality of outcomes for residents in this section is poor. The judgement has been made using available evidence, including a visit to the service. Service users’ needs are not being met by the numbers of staff employed in the home. A minimum ratio of 50 of care staff are trained to NVQ level 2 in care or equivalent. Service users are not supported and protected by the home’s recruitment policy and practises. Staff are receiving regular training and are becoming competent in their work, though some gaps in staff training were identified. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 22 EVIDENCE: The provider has advised in writing that 7 first level nurses, 18 care staff, and 7 ancillary staff are employed. 10 of the care staff have NVQ level 2 or above, and 5 staff hold a current first aid certificate. Training for kitchen staff is arranged by the contractor who provides the meals service in the home. A domiciliary care service in the local area is operated by the company. The deputy manager said that although some of the agency staff employed at Manor Barn were on the working rota for the domiciliary care service, this was a “totally separate rota” from the rota for resident care at Manor Barn. Many comments were made to the inspector by residents and relatives about staffing levels, one example being “everyone seems to be busy, very overstretched”. One relative noted that call bells will ring unanswered “for ages”. On the day of the inspection the inspector noted on four occasions that bells were ringing for long periods of time (estimated at between one and a half and two minutes) and that the noise of the bells could be a source of irritation for residents and visitors. This may also indicate that staffing levels are not adequate to meet the needs of residents. The inspector also noted that in the conservatory where a number of dependent residents were seated there was no call bell and so residents there had to call out for help, which on most of the occasions there were no staff within hearing range to answer. The inspector notes that the unanswered call bells and shouts for help were not helping provide a calm and relaxed environment for residents and visitors, and indicate that there are shortfalls in the home’s ability to meet the needs of the residents accommodated. During the lunch observed, there were not always staff available to assist residents who needed support with eating, which was leading to food going cold or uneaten. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 23 On the day of the inspection, the only one to one time staff had with residents observed by the inspector was while providing personal care. A minority of staff were seen by residents and relatives interviewed as having an abrupt manner and examples were given of distress that had been caused to residents by this. Recruitment records were seen for two members of staff. The outcomes of Criminal Records Bureau checks were not with the records. In one case there was a handwritten but unsigned note on the record saying “CRB OK”. This was not seen as adequate evidence that staff are receiving the required checks which will protect residents. When asked by the inspector, the deputy manager said that as acting manager she did not have the opportunity to see the returned CRB check, but that these were held at the company’s main office. It was the view of the inspector that this is not good practice, as it does not give a manager the opportunity to assess if a risk assessment on employing the member of staff needs to be carried out. Induction records seen indicated that new staff are undergoing induction training. The deputy manager said that new carers were assigned to a senior carer who deals with their induction training. The deputy manager said that new carers must have updating manual handling training before they assist residents. Trainings undertaken by numbers of staff since July 2006 include infection control, manual handling, health and safety, and fire safety. Staff training records sampled indicate that most care staff have completed training in manual handling, food hygiene, fire procedures health and safety, protection of vulnerable adults and infection control within the past year. The provider must ensure that gaps in staff training identified in the records are acted upon. The deputy manager advised on improvements she felt had been made, such as better communication between managers and staff, that care staff no longer assisting kitchen staff so had more time for care staff, and the Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 24 medication round no longer done during lunch, which frees up more staff time to assist residents at lunch. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 25 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): OP31, OP33, OP35, OP38 The quality of outcomes for residents in this section is poor. The judgement has been made using available evidence, including a visit to the service. Service users do not live in a home run and managed by a person who has been registered as fit to be in charge, of good character, and able to discharge his or her responsibilities fully. The home is not run in the best interests of service users. Service users financial interests are safeguarded. Staff are not being appropriately supervised. The health, safety and welfare of service users and staff are not promoted and protected. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 26 EVIDENCE: Since the previous inspection the registered manager has resigned, and the position has been vacant. The deputy manager is presently taking on some of the management responsibility. Residents and relatives interviewed were concerned at the number of changes of manager that there have been in the home in the past few years. The deputy manager said she did not know if the home was actively seeking to appoint a new manager. A registered manager who is appropriately experienced and qualified in the management of care homes must be appointed within the timescales advised. Interviews with the deputy manager indicated that as far as she was aware a quality assurance system which is ensuring that the views of residents, their relatives and others are sought on how the service is performing is not in place. However, subsequent to the inspection the provider sent to the Commission the report of the quality assurance audit carried out between February 6th 2006 and March 3rd 2006 which included the views of residents and their relatives. In information sent to the Commission previous to the inspection, the provider advised that “we do not get involved in any (resident’s) financial matters, this is company policy”. There is an outstanding requirement that one to one sit down supervision with staff is provided. The deputy manager advised the inspector that one to one staff supervision has not been taking place, and there are no plans at present to begin supervision for staff. This was of serious concern to the inspector, given the allegations of poor treatment which have been made, and the adult protection investigations being undertaken. One resident said that “carers don’t get enough supervision – carers do things in a completely different way from each other”. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 27 CSCI has been advised by the provider of the most recent service checks and inspections which have taken place to maintain health and safety standards in the home. An Environmental Health inspection was carried out on the 10th July 2006. Requirements made at that inspection include the implementation of the Safer Food system in the kitchen. A copy of the Safer Food system pack was seen in the kitchen, but record templates in the pack had not been filled out. The inspector took the view that there were not sufficient records available to evidence that the system was being fully implemented. No records of environmental safety checks were available on the day of the inspection. Discussion with senior staff indicated that although staff keep an eye on things during their duties, thorough environmental safety checks are not taking place. The inspector noted safety hazards in three bedrooms visited. Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 2 X 1 Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation Requirement Timescale for action 05/02/07 2. OP7 3. OP36 4. OP18 5.1 (b) (c) The provider must ensure that each resident receives a contract or terms and conditions of service which includes the information recommended in standard 2.2 15.2 The registered person shall make 05/02/07 the service user’s plan available to the service user, and keep the service user’s plan under review after consultation with the service user or a representative of his 18(a) That all care staff must receive 05/02/07 formal supervision at least six times a year (this requirement is outstanding from the last 2 inspections. The previous timescale was 01/12/05) 13(6) Training in local adult protection 02/03/07 procedures should be made available to relevant staff 12.1 Arrangements should be made whereby a photograph of the resident to receive the medication is checked before the DS0000024175.V314727.R01.S.doc 5. OP9 05/02/07 Manor Barn Nursing Home Version 5.2 Page 30 medication is given. 6. OP8 24 The provider should consider if the care of residents would be improved by key worker roles being extended. 05/02/07 7. OP26 12.1 03/01/07 The provider needs to ensure that infection control policies and procedures and staff implementation of them reflect current good practice. A record should be kept of all complaints made and include details of investigations undertaken and any action resulting The provider must act to ensure incidents reported of staff behaviour causing distress to residents is investigated and appropriate action is taken 03/01/07 8. OP16 17 9. OP18 12.5 03/01/07 10. OP27 18.1 (a) The registered person shall, having regard to the size of the care home and the number and needs of service users ensure that at all times suitably qualified and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users The registered person must so far as practicable enable service users to make decisions with respect to the care they are to DS0000024175.V314727.R01.S.doc 05/02/07 11. OP14 12.2 05/02/07 Manor Barn Nursing Home Version 5.2 Page 31 12. OP38 13.4 receive and their health and welfare The provider must comply with requirements made during the environment health department inspection of 10th July 2006 within the timescales given. 10/02/07 13. OP38 13.4 14. OP31 8 The provider needs to ensure that regular, recorded environmental safety assessments are being undertaken in the home, and that action is taken to minimise safety hazards A registered manager who is appropriately experienced, competent and qualified in the management of care homes must be appointed. The registered person shall produce a plan (the improvement plan) setting out the methods by which, and the timetable to which, the registered person intends to improve the services provided in the care home. The registered person shall provide a written copy of the improvement plan to the Commission within one month of receipt of this request. A copy of the plan shall be made available to service users and their representatives. 05/02/07 26/02/07 15. OP33 24A 05/02/07 Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 32 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 Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Manor Barn Nursing Home DS0000024175.V314727.R01.S.doc Version 5.2 Page 34 - 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!