Inspection on 22/11/06 for Manor Court

This inspection was carried out on 22nd November 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Manor Court 15/06/07

Manor Court 14/10/05

Manor Court 04/05/05

Manor Court 14/09/04

Manor Court 28/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Manor Court 257 Blandford Road Efford Plymouth Devon PL3 6ND Lead Inspector Antonia Reynolds Unannounced Inspection 22nd November 2006 11:00 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 Court DS0000003540.V321161.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 Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor Court Address 257 Blandford Road Efford Plymouth Devon PL3 6ND 01752 768425 01752 785781 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) sharon.blackwell@anchor.org Anchor Trust Debra Michelle Attridge Care Home 37 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (37), of places Physical disability over 65 years of age (37) Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. DE(E) Category for a maximum of 5 residents only Age 60 yrs To admit one named Service User aged 55 years. Date of last inspection 14th October 2005 Brief Description of the Service: Manor Court is a care home providing personal care and accommodation for thirty seven people, over the age of 60, who may also have physical disabilities, five of whom may have dementia. The home does not provide intermediate care. The home is owned by Anchor Trust, a national voluntary sector organisation. The Registered Manager is Mrs Debra Gardner. The fee levels are between £280 and £450 per week, although these may vary depending on the individual needs of service users. Information about the service and copies of inspection reports can be obtained from the home. The home was opened in 1990 and is a purpose built, two storey building situated in the residential area of Efford. It is close to local shops and amenities and public transport is easily available. All the rooms, which are small self-contained flats, are for single occupation and are on the ground and 1st floors. They all have a small kitchen area and en suite toilet facilities. Thirty-four rooms also have en suite level access showers. In addition to the en suite facilities the home has three wellequipped bathrooms, which contain baths, showers and toilets. Two of the baths are assisted, one with a jacuzzi system. There are also two separate toilets. There is a combined dining and lounge room on the ground floor and a smaller lounge room on the 1st floor. The home has two passenger lifts and all areas are accessible by wheelchair users. There is parking space available at the front of the home, as well as on street parking nearby. The home has a large garden to the rear of the property. Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection consisted of three unannounced visits. The first visit took place between 11.00am and 3.30pm on Wednesday, 22nd November, the second between 11.55am and 5.30pm on Thursday, 23rd November and the third between 3pm and 5pm on Tuesday, 28th November 2006. The senior staff member on duty, Sarah Hall, was present on the first visit, and the Acting Manager, Karen Farouqa, was present during the latter two visits. A tour of the premises took place and records/documents relating to the care of the service users, staff and the home were inspected. A pre-inspection questionnaire had been completed by the Registered Manager, which contained information relevant to the inspection. Survey forms had been completed by four service users and twenty-four service users were spoken with or observed during the visits. Seventeen were spoken with at greater length. Relatives and other individuals/agencies involved with the home were written to and asked their views of the home. Replies were received from five relatives. No responses were received from health and social care professionals. What the service does well: The service users described the staff as being very kind, caring and attentive. They said that living in Manor Court was “very good”, “a lovely place to be” and that the atmosphere was like living as “one family”. The standard of personal accommodation is excellent as each service user has a self-contained flat with space for a bed, comfortable seating, a kitchen area and en suite toilet. Most of the flats (34 out of 37) also have an en suite level access shower. This type of accommodation enables service users to live as independently as they wish with the knowledge that care staff are available for support. Service users described the meals as very good. They are informed about menus in advance but do not have to choose a meal until the particular meal time comes around, thereby allowing people to see what is available and they have the opportunity to change their minds at short notice. The ethos of the home promotes service users’ wellbeing by recognising their rights to independence and autonomy, for example, to retain their own medication. Social activities are varied and active participation in the local community is encouraged. Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 7 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 Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 8 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): Standards 3, 4 and 5 Quality in this outcome area is good. Thorough and comprehensive procedures prior to admission ensure that service users and their relatives can be confident that their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre-admission assessment process ensures that the needs of prospective service users are identified. Service users and their relatives are welcome to visit the home prior to admission to meet other service users, staff and have a look around the home. Discussions with service users, staff and the management team, as well as observation, show that staff are aware of the needs of the service users. The home does not provide intermediate care. Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 9 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): Standards 7, 8, 9, 10 and 11 Quality in this outcome area is good. Service users can be confident that they will be treated with respect and that personal and health care needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users’ files contained care plans, individual lifestyle agreements and risk assessments relating to health and personal care needs that are regularly reviewed. Discussion with service users, staff and the management team, as well as observation and information from relatives, confirmed that personal care is maintained, service users can bathe/shower when they choose to and are encouraged to be as independent as possible. Information contained in care plans showed that service users have access to health care service services such as doctors, district nurses, opticians, chiropodists, dentists, dieticians and the mental health team. Service users confirmed that referrals are made to other relevant professionals when required. Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 10 Privacy is respected and staff were observed always knocking on doors before entering private rooms. The home has a telephone booth with a pay ‘phone on the 1st floor for service users to make private ‘phone calls. However, service users may also use the home’s telephone or have private telephones installed in their bedrooms at their own expense. Some service users have mobile telephones and confirmed that the reception was good. Service users said that they are very well looked after by staff who are kind, caring and helpful. They also commented that the staff spend time talking to them, despite being busy, and nothing is too much trouble. Staff were observed treating all the service users with kindness, consideration and respect. Comment cards from relatives also expressed satisfaction with the care being provided. With regard to medication, the home’s policy encourages service users to be self-medicating and keep their own medication in their rooms, subject to risk assessment. Service users confirmed that they could keep their own medication if they wished to and are provided with lockable space in their rooms to keep it. Where medication is administered by staff, it is stored securely, a monitored dosage system is used for the majority of medicines and the home has a refrigerator specifically for storing medicines that need to be kept at low temperatures. However, the practices relating to its administration were not entirely satisfactory because the records showed that, occasionally, staff had not been following the home’s written procedure for the administration of medicines. There were blank spaces on the administration records where some kind of notation should be made to show what had happened to the medication, for example, if the service user had declined it on that occasion. One service user’s record had been signed by a staff member to indicate that the medication had been given, but the tablets were still in the blister pack. Before the inspection was finished, the Acting Manager confirmed that action had been taken to ensure that this did not occur again and that the relevant staff members would receive additional training in the administration of medication. Service users with terminal illnesses can remain in the home as long as their needs can be met by the staff and the community health team. A recent situation in the home has emphasised the need for the management and staff team to be fully aware of the wishes of service users and their relatives, as well as any funeral arrangements that need to be made. Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 11 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): Standards 12, 13, 14 and 15 Quality in this outcome area is good. The routines in the home are relaxed, relatives and friends can be confident that they are welcomed and social activities are arranged. Dietary needs of service users are well catered for with a balanced and varied selection of food that meets service users’ tastes and choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are very positive about the lifestyle in Manor Court. They said that they choose where they spend their day, the times they get up and go to bed, when they want to have a bath/shower, whether they want to go out and what colour scheme they would like when their flats are due for redecoration. They confirmed that visitors are welcome at any time and they particularly enjoy the interaction and conversation with staff. The home has a designated activities co-ordinator, service users said they enjoy the activities provided and are each given a list of forthcoming events. Trips out are arranged on a regular basis to local places of interest, the garden centre or for individual shopping. Various events take place in the home, such Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 12 as clothes fairs, musical entertainment and a pantomime production company are performing ‘Jack and the Beanstalk’ in December. There is a bric-a-brac sale being held soon to raise money towards the buying of a minibus for the home. At present, the home has the use of a minibus but service users have requested their own, so that timings of trips out can be more flexible. Overall, the quality of the food was praised and everyone said they have a choice of meals. There is a menu on display in the main entrance hall and each service user is given a personal copy each week. Service users are not expected to make a choice until meal time and the chef ensures that there is always enough of each menu item available. Service users confirmed they can have meals in their flats if they wish to and that fresh fruit is always available. Special diets are catered for and, where required, nutritional plans are in place that follow advice given by doctors and dieticians. Each flat contains a kitchen area and service users are provided with victuals of their choice so that they can make their own drinks and snacks, or staff can prepare these for them in their own rooms. Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 13 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): Standards 16, 17 and 18 Quality in this outcome area is good. Service users can be confident that any concerns or complaints are treated seriously and that they will be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a written complaints procedure and service users know how, and to whom, to make a complaint should they need to. Service users said that they had confidence in the management and staff team to resolve any issues as soon as they arise. However, service users also said they have no complaints about the home or the care they receive. All staff have attended, or were expected to attend, training related to the protection of vulnerable adults and staff are clear about the procedure to follow if necessary. There is a visitors book in the front hallway to record dates, times and names of all visitors to the home. Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 14 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): Standards 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is excellent. The service users live in a pleasant, well-maintained home that is large, comfortable, warm and provides sufficient facilities to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is purpose built, well maintained, spacious and adapted to accommodate people with physical disabilities. On the days of inspection new ‘hold open’ devices were being fitted to all fire doors, which should enable service users to move even more easily around the home. All private and communal rooms are nicely decorated and furnished and service users confirmed that the home is comfortable and is kept very clean and warm. Private accommodation for service users consists of a self-contained flat with a front door with letterbox and spy hole, so service users can check who is Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 15 outside the door before they open it, should they wish to. Each flat is large enough to contain a bed, comfortable seating and a kitchen area, as well as having en suite toilet facilities. Most of the flats (34 out of 37) also have en suite level access showers. All the flats were well decorated and maintained and service users said they could choose the colour of the décor when redecoration is due. Lockable storage facilities are provided in every flat. Service users may subscribe to Sky TV if they wish to. Service users said they were satisfied with the laundry arrangements and none of the service users spoken with had experienced any items going missing or being damaged. The garden is large, mainly laid to grass and provides a pleasant, safe environment for service users. Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 16 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): Standards 27, 28, 29 and 30 Quality in this outcome area is good. Service users are cared for by motivated and caring staff in sufficient numbers to meet the needs of those currently living in the home. Recruitment practices protect vulnerable service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observation and discussion with service users and staff confirmed that the staff team were respectful, polite, attentive and responsive to service users’ needs. Service users described the staff as very kind and caring and confirmed they responded promptly to requests for assistance indicating that there are sufficient staff to meet the needs of those currently living in the home. Care staff are supported by catering, laundry, domestic and maintenance staff, as well as the management team and an activities coordinator. The management and staff team confirmed that staffing is flexible depending on the needs of the service users. Comment cards from the relatives of one service user said they did not think there were enough staff on duty and the Acting Manager has agreed to keep staffing levels under review. Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 17 There has been a rather high turnover of staff in the last year, mainly to ensure a good quality of care for the service users. However, there is comprehensive induction training for all new staff. Staff confirmed that they are expected to participate in various training sessions and courses including health and safety, first aid, manual handling, fire safety, food hygiene, dining with dignity, dementia awareness and National Vocational Qualifications. Designated staff undertake medication training. The home subscribes to Community Care so that the management are aware of up to date practices in social care. Recruitment processes are robust in that two written references are obtained as well as a Criminal Records Bureau (CRB) check and staff confirmed that they were not left unsupervised until they had completed a full week’s induction and a satisfactory CRB check was obtained. Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 18 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): Standards 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. Service users live in a well managed home. The management and staff team strive to provide a stimulating, safe environment where service users are respected and rights are upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager was not available during the inspection process, however the previous inspection confirmed that she is appropriately experienced and qualified with an NVQ4 in Care and a Diploma in Management. The management arrangements in her absence are satisfactory, in that an Acting Manager and Deputy Manager have been appointed, overseen by the organisation’s Area Support Home Manager. Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 19 Staff confirmed that they are well supported by the management team on a day to day basis, through regular staff meetings and supervision sessions. However, the on call system used to contact senior staff during the evenings and at weekends needs to be clarified. The service users or their families/representatives manage their financial affairs, although the home does manage small amounts of spending money on behalf of service users via a bank account set up specifically for this purpose. The records relating to this account were up to date and audited by the home’s manager. Advice was given to ensure that service users sign for any money given to them from this account, so that there is a clear audit trail of money in and out of the account. Service users said that they feel safe and secure in their home and that the home is well managed. Health and safety practices are satisfactory in that equipment is maintained in good working order and staff receive training in health and safety, fire safety, first aid, food hygiene, infection control and manual handling. Inspection of the fire logbook indicated that the required weekly and monthly tests/checks of the fire alarm system/equipment are carried out. However, records relating to the checking of fire extinguishers could not be found, although the Acting Manager confirmed these checks take place. A quality assurance system is in place and service users’ views are sought through meetings or individually. Before a care plan review, each service user is asked to complete a questionnaire about their level of satisfaction with life in the home. Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 163 3 17 3 18 3 4 4 4 4 4 4 4 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 21 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. Standard Regulation Requirement Timescale for action 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 Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Manor Court DS0000003540.V321161.R01.S.doc Version 5.2 Page 23 - 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!