CARE HOMES FOR OLDER PEOPLE
Manor Farm Hill Road Ingoldsthorpe Kings Lynn Norfolk PE31 6NZ Lead Inspector
Mrs Jacky Vugler Unannounced Inspection 24th April 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 Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Manor Farm Address Hill Road Ingoldsthorpe Kings Lynn Norfolk PE31 6NZ 01485 541977 01485 544325 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) The Drive Care Homes Ltd Carl Anthony Harris Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th October 2005 Brief Description of the Service: Manor Farm House is a large detached building situated on the edge of the small rural village of Ingoldisthorpe. There is parking to the front and side of the home with attractive gardens to the rear of the Home. Ingoldisthorpe has few local facilities but the towns of Hunstanton and Kings Lynn are both a short drive away. The home provides care for up to seventeen elderly people. Information regarding this service is available in the entrance hall. The range of fees as stated by the Manager on 31 March 2006 is £350 - £700 a week. Additional charges include newspapers, telephone and transport; hairdressing at £5 - £17.50 and Chiropody £8. Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced Key Inspection taking place on a weekday. Mr Carl Harris, the Manager, was present during the inspection. Preparation for the inspection had taken place at the CSCI office. There were thirteen residents accommodated on the day. A tour of the premises was undertaken. Several records were viewed, and five residents, a visitor and three members of staff were spoken to privately. One comment card was received from a resident and two from relatives. They were satisfied with the service provided by the home. What the service does well: What has improved since the last inspection?
It is felt that this home is improving. The Manager is in the process of implementing new care plans. These are much more detailed than the previous ones and would give better guidance to staff about how to meet the individual needs of the residents. The preadmissions assessments, care plans and risk assessments are now kept together and available to staff. There is now a daily programme of activities, which is displayed in the hallway, although not very clearly. The complaints procedure and forms are now kept in a folder in the entrance hall with the information about the home. Four members of staff are currently undertaking the NVQ level 2 and the Manager said that he plans to commence another four staff when they have completed it. The home has more permanent staff and is therefore using less bank staff, which ensures better continuity for the residents. There have been several improvements to the environment; for example, the driveway has now been gravelled. The kitchen, first floor bathrooms, a bedroom, downstairs bathroom and the hallway have been repainted. The fence surrounding the property has been removed making the area look more
Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 6 spacious. Two new home signs have been purchased and are waiting to be erected. There is an ongoing programme of redecoration. Staff lockers have been installed. 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. Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 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 Farm DS0000042229.V292041.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. Prospective residents have their needs assessed prior to admission. Standard 6 is not applicable. EVIDENCE: The pre-admission assessments are now stored with the care plans and accessible to staff. They contain all the necessary information. Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. Residents are looked after well in terms of their health and personal care needs. The care plans are improving and being reviewed regularly. The storage of medications promotes good health. EVIDENCE: The home is in the process of changing to new care plans, which contain more detail and therefore provide more guidance to staff. These care plans are also being further improved as they are being implemented. Five care plans were viewed and two were in the new format. The new style care plans contain a life story, but many of these are not yet completed. One resident said, “staff are aware of our needs”. Since the last inspection, the initial assessment and the risk assessments are kept in the care plan and available to staff. The care plans seen were reviewed monthly and signed by the resident. Evidence was seen of the involvement of other healthcare professionals. Medications are stored and recorded appropriately. A letter, signed by the GP is kept for the use of homely remedies. Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 10 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): 12, 13, 14, 15 Quality in this outcome area is good. The home meets the social and recreational needs of the residents. Residents are able to maintain contact with family and friends and to exercise choice and control over their lives. EVIDENCE: Activities are now provided daily by the staff on duty. Also regularly staff put aside time to talk to the residents on a one-to-one basis. The Manager talked of setting up scrapbooks for the residents. It was reported that a lot of the residents like to stay in their rooms or the conservatory and that the staff try to encourage them to take part. An outside entertainer visits monthly for singing and some residents enjoy that. The home has purchased a music system for different types of music and a Karaoke machine, but this was not very successful. Boots and a book club visit to enable residents to shop independently. One service user likes to help with daily tasks e.g. folding the napkins. Some residents are interested in gardening and it is hoped that this can be available to them in the warmer weather. The Manager reported that a day trip is being organised for summer, a meeting will be held with the residents in May for their opinions on what to do and families will also be welcomed. Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 11 The home has an open visiting policy and visitors to residents are recorded in their daily records. Resident spoke of the choices available to them. Residents were seen to have their meals where they want, for example, in the dining room or their bedroom. One resident always has meals in her room and two like to get up early. The menus provided are nutritious and varied, and the meals are nicely presented. The dining room is pleasant with tables seating four. One resident complained that there was no choice at teatime, but all the other residents spoken with said that there was a choice of a cooked tea or sandwiches. Five members of staff have completed the food hygiene training. The environmental health officer visited in March 2006 and there were no requirements. Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 12 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 Quality in this outcome area is adequate. Arrangements for protecting residents’ and responding to their concerns are in place. The residents’ are not entirely protected from financial abuse. The home needs to be more pro-active in providing lockable facilities for the residents in order to safeguard their valuables. EVIDENCE: The complaints policy and forms are now kept in a folder by the visitors book, and this also contains the statement of purpose, service users guide and service user satisfaction questionnaires. The inspector suggested a contents list on the front, so that visitors would know that the complaints information is in there. There is an outstanding CRB disclosure for one member of staff, but the POVA check has been returned clear. The issue of door locks and lockable facilities in residents’ bedrooms is dealt with elsewhere in this report. The Manager has devised an informative document about abuse awareness and all staff keep a copy. Some staff have completed training in abuse awareness and some have covered it in their NVQ training. It is a requirement of this report that all staff complete training in abuse awareness. Acton has been taken regarding the allegations of thefts and since then no additional thefts have occurred.
Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 13 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, 25, 26 Quality in this outcome area is adequate. A comfortable, well maintained standard of accommodation is provided for the residents. However, in some areas, this is not considered to be a safe environment. EVIDENCE: This is a pleasant, well-maintained home. As stated earlier in this report, several improvements have been made to the environment since the last inspection and there is an ongoing programme of redecoration. The residents’ bedrooms looked homely and contained their personal possessions. However, there is no lockable storage space provided in which they could keep any valuables. The Manager said that residents have been asked if they would like this facility, but all have refused and this is recorded. It is a requirement of this report that lockable doors and facilities in bedrooms are provided as standard. It should then be documented if the resident does not want to use this facility.
Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 14 Some radiators have been fitted with protective covers and it is the Managers opinion that those not covered are safe. It is a requirement of this report that a risk assessment is completed for any uncovered radiator and a cover fitted where a risk is highlighted. Although the hot water at the baths is regulated, it was noticed during the inspection that hot water at the hand washbasins was very hot. It is a requirement of this report that thermostatic control valves be installed at the hand washbasins and that risk assessments be completed. The windows on the first floor do not have restrictors fitted, however due to their design many of them have restricted opening. It is a requirement of this report that risk assessments are completed with regard to falls from first floor windows. The home is clean and tidy, free from unpleasant odours. Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 15 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): 26, 27, 28, 29 Quality in this outcome area is good. The residents’ needs are met by the numbers and skill mix of staff, however, the home must continue to ensure staff receive training to NVQ level 2 standard. The residents’ are protected by the homes recruitment practices. EVIDENCE: The home provides a senior and a care assistant for the daytime hours and two care assistants during the night. A senior member of staff is always ‘on call’. In addition there is a cook every day, a domestic five days a week and a maintenance person. Four staff files were viewed and these contained all the necessary recruitment information including the Criminal Record Bureau disclosures. Staff probation forms were seen and induction records. Each staff member has a personal development file and training certificates were seen. Four staff plan to finish the NVQ level 2 by June and at that point it is planned for another four to start. The Manager said that he plans to commence the Skills for Care training with the two most recent members of staff. This will be good practice. Training undertaken includes fire awareness, moving and handling, foundation food hygiene, dementia and abuse. The manager said that he is planning to update the training files. Lockable staff lockers have now been installed. Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. The manager is supported well by the senior staff and has worked hard to comply with the requirements of the last report. The home would better safeguard residents’ interests if there were a system in place for monitoring the quality of services provided. EVIDENCE: Mr Harris, Manager, has now completed the NVQ level 4 in care and is soon to commence the RMA. Staff have not undertaken training on infection control and it is recommended that this be addressed. The financial records were satisfactory and random monies were checked and correct. Income and expenditure were recorded and receipts were kept, and when requested, statements are printed for families. The Manager said that one resident continues to manage her own finances and refuses to accept lockable facilities and this is documented.
Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 17 Although, since the last inspection, the organisation has carried out more frequent unannounced visits to the home, these must increase to every month. There is no system in place for monitoring the quality of the service provided. Some service user satisfaction surveys have been completed and it is required that the results of these to be collated and forwarded to the CSCI office. The manager said that the company were looking into the possibility of an accredited quality assurance system. It is a requirement of this inspection that a quality assurance system is implemented. Health and safety building risk assessments were seen and they are very basic. A health and safety inspection checklist is completed monthly. It is recommended that the buildings risk assessments contain more detail and address the issues highlighted elsewhere in this report. The fire records and risk assessments were seen and these were satisfactory. There were no requirements from the Fire Officers last visit to the home. Current service certificates were seen for the equipment used in the home. Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 18 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 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 x x x x 2 1 3 STAFFING Standard No Score 27 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 3 3 x 2 Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP33 Regulation 26 Requirement The organisation must carry out monthly, unannounced visits and send a copy of the report to the Commission. (Previous timescales of 31.5.05 & 31.12.05 not met). The registered manager must ensure that all staff receive training in abuse awareness. The registered manager must ensure that residents are provided with lockable storage space within their rooms for medication, money and valuables. The registered manager must undertake a risk assessment of falls from first floor windows and install window restrictors wherever necessary. The registered manager must risk assess the issue of residents’ contact with hot surfaces of radiators and install radiator guards where a risk is highlighted. The registered manager must ensure that appropriate systems are in place to ensure that hot
DS0000042229.V292041.R01.S.doc Timescale for action 30/06/06 2 3 OP18 OP24 13 (6) 16 (2)(l) 31/08/06 31/08/06 4 OP25 23 30/06/06 5 OP25 13 30/06/06 6 OP25 13 30/06/06 Manor Farm Version 5.1 Page 20 7 OP28 18 8 OP33 24 water tap temperatures remain close to 43’C and that this is checked regularly (with records kept). The registered manager must ensure that at least 50 of staff receive training to NVQ level 2 standard or equivalent. The registered provider must ensure that a system of quality assurance is implemented. This must include systems for reviewing and improving the quality of care, including consulting with residents and their relatives and producing a report on any review carried out (to be supplied to the Commission and made available to residents). 30/09/06 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP38 Good Practice Recommendations It is recommended that the care plans reflect the resident’s previous lifestyle. It is recommended that staff receive training in infection control. Manor Farm DS0000042229.V292041.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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