Inspection on 06/05/05 for Manor Farm

This inspection was carried out on 6th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 Farm 03/09/07

Manor Farm 24/04/06

Manor Farm 18/10/05

Manor Farm 23/09/04

Manor Farm 29/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Manor Farm House Hill Road Ingoldsthorpe Kings Lynn PE31 6NZ Lead Inspector Lella Andrews Unannounced 6th May 2005 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 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 House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Manor Farm House Address Ingoldsthorpe Kings Lynn PE31 6NZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01485 541977 01485 544325 The Drive Residential Home 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 House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd September 2004 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. In May 2003 the home was purchased by an organisation known as The Drive Residential Homes Ltd. Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was unannounced and took place between 5.30am and 10.30am. The Inspection took place as a result of the Commission having received a complaint about poor staffing levels at night. As a result of the Inspection the complaint is found to be substantiated. The Inspector spoke to three members of staff and to three of the residents. The medication system was looked at. The Inspector also looked at the staffing rotas and residents care plans. The Inspector spoke to the Manager and the Responsible Individual for the organisation by telephone during the Inspection. An Immediate requirement with regard to improving staffing levels was issued during the Inspection. What the service does well: What has improved since the last inspection? What they could do better: The staffing situation needs to be addressed so that there are sufficient staff on duty during the evenings, nights and early mornings. An Immediate Requirement has been issued with regard to this. The Manager needs to ensure that individual members of staff are not working too many hours, and therefore becoming too tired to carry out their duties properly. Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 6 Alterations need to be made to the current medication system in order to make it more secure and also to ensure that risks are assessed adequately. The care plans need to contain clear guidance to staff about how to meet the needs of the residents and risk assessments need to be improved. These records need to be regularly reviewed and updated. The organisation needs to carry out the required monthly visits in order to be confident that any difficulties are highlighted and can be addressed adequately. 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 House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 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 standard(s) none of these standards were measured EVIDENCE: N/A Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 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 standard(s) 7 and 9 The individual care plans that the staff have access to have not been regularly reviewed and updated and therefore do not provide adequate guidance for staff with regard to meeting individual needs. The medication procedures need reviewing to improve the protection offered to service users EVIDENCE: Three care plans were looked at. The initial assessment and any risk assessments are kept locked in the managers office and so staff do not have access to these. Instead, the staff have access to copies of the care plans which are based on the assessments. These have not been regularly reviewed or updated despite changes to the service users needs evident through the daily notes kept by staff. It was also noted that the assessment carried out by the Manager differed from that carried out by the hospital the previous day with regard to one of the residents with no clear evidence of why this was so. It is required that the care plans are kept under review and updated as ncessary Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 10 Moving and handling assessments are completed for residents on admission but these are not available to staff. The care plans with regard to mobility were not detailed enough to provide adequate guidance to staff, particularly with regard to the use of the hoist. Risks assessments have not been undertaken for all necessary situations. The particular ones noted to be missing were with regard to pain control, self medication and residents going out alone. It is required that the care plans provide detailed guidance to staff with regard to meeting individual residents needs and that the plans are available to staff at all times. It is required that risks are identified and assessed appropriately The staff complete daily notes at the end of each shift and these are used to handover information from one shift to the next. These notes should be monitored by the Manager to ensure that any identified changes in the needs of the residents are identified and that the care plans are updated accordingly. The storage arrangements and administration records relating to medication were looked at in detail. The Home uses a monitored dosage system and keeps appropriate administration records for medication dispensed in this way. The medication in use on a daily basis is stored appropriately. The staff advised that training is provided by senior staff with regard to the administration of medication. There is a clear, separate record of any changes made to residents medication and also a record of samples of staff signatures, both of which are good practice. The Home keeps additional medication eg creams, bottles of liquid medication and medication waiting to be returned to the pharmacy in a cupboard in the Managers office. Staff said that the office is kept locked when the Manager or Senior staff are not at the Home but the cupboard is not actually locked. There are times when the office is unlocked with no-one present. It is required that medication is stored in a locked cupboard. Staff advised that one of the residents looks after their own medication on a daily basis. This medication is also stored in the unlocked cupboard. The care plan contradicts itself as it states in one place that staff administer medication and in another that the resident self medicates. There is no risk assessment for this situation. Staff advised that the resident does not have lockable storage in their room to keep medication in. It is required that a risk assessment is undertaken for the resident who self medicates. It is required that lockable storage is provided for the resident who looks after their own medication. Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 11 Medication waiting to be returned to the pharmacy is kept in the unlocked cupboard. This includes medication belonging to a resident who died in January 2005. It is required that medication no longer required is returned to the pharmacy on a regular basis. Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 12 Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 The lack of staff available during some evenings, nights and early mornings reduces the ability of the staff to meet the residents choices about who provides personal care and at what times they go to bed and get up. EVIDENCE: Rotas were seen from 14th February 2005 to the day of the Inspection. During this time there were only three weeks when there were two waking night staff on duty every night. As the day staff finish work at 8pm this means that there is only one member of staff in the Home from 8pm to 8am on the days when there is only one waking night staff. Staff advised that this means that they are not always able to answer call bells quickly and that if a resident needs two staff to assist them then they may have to get ready for bed earlier or get up later than they would normally choose to. The Home has one male member of staff who undertakes day and night duties. Whilst it is positive for residents to be able to choose the gender of the care staff who assist them this is not possible when there is only one member of staff on duty. Staff advised that this has meant that female residents who do not wish to be assisted by a male member of staff have had to go to bed earlier than they might usually do so that female staff can assist them. Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 14 Residents advised that the staff work hard but that they are very busy, particularly at night and that they sometimes have to wait for the bells to be answered. Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) neither of these standards were measured EVIDENCE: N/A Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none of these standards were measured EVIDENCE: N/A Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The staffing levels in the evenings, nights and early mornings have not been sufficient to safely meet the residents health and welfare needs. Some members of staff have worked excessive hours which increases the risk of them making errors due to being tired. EVIDENCE: The staffing rotas confirmed the views of the staff about the provision of night staffing over the previous three months. The rotas show that for twenty one of the previous seventy four nights there has only been one member of staff on duty from 8pm to 8am. Many of the service users require assistance during the night, and care plans show evidence that staff have had to deal with situations requiring two members of staff eg. residents who have fallen or who wander around the Home during the night. The reduction in staffing provision has meant that the health and welfare needs of the residents have not always been able to be met adequately. The situation has not been safe for either residents or staff. An Immediate Requirement was issued during the Inspection which required there to be two staff on duty from 7am and 10pm. It also required there to be one waking night staff and one staff sleeping in from 10pm to 7am with this provision increased if the needs of the residents increase. Staff are keen to provide a good level of support to the residents and so, on occasions, have been working excessive hours. One of the staff did say that Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 18 this situation was of their own choosing. The two senior staff have also been providing an oncall service to the other staff. There have been many times over the last few months when they have worked additional hours to provide support to their colleagues. It is required that the Manager monitors the amount of hours that staff are working/on call to ensure that they are able to carry out their duties effectively. Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 Residents have been put at risk by poor management decisions affecting the staffing levels at the Home EVIDENCE: The Manager was contacted by telephone during the Inspection and the Responsible Individual was contacted shortly after and so their views about the poor staffing levels were sought. The Commissions records show that an agreement was made with the Manager in February 2005 to enable the Home to reduce the two waking night staff to one waking and a sleep in for a few days following a suitable risk assessment by the Manager and that the Home would return to two waking night staff the following week. The rota does not indicate that sleep in staff were provided at that time. The Commission has not had any further contact from the Manager with regard to difficulties in the provision of staff. Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 20 The care plans indicate that at that time an effective risk assessment is likely to have indicated that there was a need to continue with two night staff rather than one and a sleep in. One of the residents who required additional support is no longer living at the Home. The information gathered from staff and the written records indicates to the Inspector that currently the residents needs could be met by one waking night staff and a member of staff sleeping in as long as there are two staff on duty from 7am to 10pm. However, if the needs of the residents increase then the night staffing arrangements must be reviewed and increased accordingly. It is of concern that the Responsible Individual was not aware of the poor staffing situation. The last Regulation 26 visit report that the Commission has received was for January 2005. It is required that unannounced visits take place on a monthly basis as per Regulation 26 Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 1 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x 1 x x x x x x Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 22 N/A 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. 2. Standard 7 7 Regulation 15 (2) 15 (1) Requirement It is required that the care plans are updated and that they are reviewed on a monthly basis It is required that the care plans contain detailed guidance for staff about how to meet individual needs It is required that risks are identified and adequately assessed It is required that all medication is stored in a locked cupboard It is required that residents who are resonsible for their own medication are provided with a locked space in which to keep them It is required that a risk assessment is undertaken for residents looking after their own medication It is required that medication which is no longer in use is returned to the pharmacy on a weekly basis It is required that there are two members of staff on duty from 7am to 10pm and that there is one waking night staff and one sleep in staff on duty from 10pm Timescale for action 30th June 2005 30th June 2005 30th June 2005 Immediate and ongoing 31st May 2005 3. 4. 5. 7 9 9 13 (4) 13 (2) 13 (2) 6. 9 13(4) 31st May 2005 31st May 2005 Immediate 7. 9 13 (2) 8. 27 18 (1a) Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 23 9. 27 18 (1a) 10. 33 26 to 7am. This must be increased if the needs of the service users increase It is required that the manager monitors the amount of hours that staff work or on call to ensure that they can carry out their roles effectively It is required that the organisation carries out montly unannounced visits and that a report is sent to the Commission 31st May 2005 31st May 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Manor Farm House I55s42229manorfarmhousev226068060505(4).doc Version 1.30 Page 24 Commission for Social Care Inspection 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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