Inspection on 01/08/05 for Manor Farm Care Home

This inspection was carried out on 1st August 2005.

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 Farm Care Home 29/04/08

Manor Farm Care Home 15/10/07

Manor Farm Care Home 02/10/06

Manor Farm Care Home 07/11/05

Manor Farm Care Home 21/12/04

Manor Farm Care Home 24/05/04

Manor Farm Care Home 02/12/03

Manor Farm Care Home 16/09/03

Manor Farm Care Home 29/08/02

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

CARE HOMES FOR OLDER PEOPLE Manor Farm Nursing Home 211-219 High Street South East Ham London E6 3PD Lead Inspector Nurcan Culleton Unannounced Inspection 1 August 2005 at 11.30am st 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 Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Manor Farm Nursing Home Address 211-219 High Street South, East Ham, London, E6 3PD 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) 020 8548 8686 020 8548 9929 treespark.eh@btconnect.com Trees Park (East Ham) Limited Jacqueline Bridget Philomena Connolly Care Home 81 Category(ies) of Dementia - over 65 years of age (58), Old age, registration, with number not falling within any other category (23) of places Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 21st December 2004 Brief Description of the Service: Manor Farm is a purpose built residential care home that is situated in East Ham, close to public transport and other community amenities.The premises are spacious, comfortable, well furnished and maintained. There are single and double bedrooms and all bedrooms have en-suite facilities. There are front and back gardens and ample parking facilities.The home is registered with the Commission for Social Care Inspection to provide care for up to 81 older people. The building is divided into three units, one on each floor. The top floor is residential, while the ground and the fist floor are nursing care units.The Registered Provider is Trees Park (Manor Farm) Ltd. The company is part of a group of Care Homes. Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 1st August 2005. The Registered Manager assisted the inspector throughout the inspection. The inspector also spoke with three service users, three staff members and two visiting relatives. The inspector also viewed a variety of documentation including service users’ files, staff files, health and safety records and policies and procedures. A complaint of a serious nature concerning and the care received by a service user was investigated by the CSCI inspector prior to this inspection. The inspector upheld the main complaint concerning the neglect of a pressure sore, namely in respect of the lack of recorded evidence to demonstrate that good practise and proper procedures were followed. These issues were further examined in this inspection. What the service does well: What has improved since the last inspection? What they could do better: Requirements arising from the above mentioned complaint have been incorporated into this inspection as they relate directly to the home’s use of documentation and its recording practises, as also examined in this inspection. Requirements related to this complaint and evidence seen in this inspection concern inadequate recording of documents, such as care plans, which lacked sufficient detail as related to actions required to meet service users’ needs; personal care charts were incorrectly coded and observation notes lacked sufficient detail and did not relate directly to care plans. Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 Page 6 It is now imperative that the Registered Manager takes on board the importance of improving recording procedures, as required by NMS regulation. Whilst the home has a range of policies and procedures in place, the home lacks policies and procedures specific to the home on expected standards of performance as related to recording practises. This is particularly noticeable in the use of all documentation concerning the care and treatment of service users. Such written procedures are necessary to standardise and improve recording practises; to provide evidence of observations made and of care and treatments given. Other requirements include the lack of evidence of consultation with service users for significant documents involving them directly and some issues concerning the health and safety of service users related to their environment. The Registered Manager must ensure that the home follows robust systems, and that policies and procedures are in place and strictly observed in order to safeguard the health, welfare and best interest of service users. Requirements given in this report are made to address serious shortfalls in practise and must be complied with within the timescales specified in this report in order to avoid enforcement action in future. 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 Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 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 Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 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) 1, 3, 4, 5, Service users are given information about the home to enable them to enable them to make an informed choice about moving to the home. Service users’ needs are assessed prior to and following admission and are met by the home. EVIDENCE: A previous requirement concerning the Statement of Purpose and Service Users’ Guide was met. The Statement of Purpose and Service Users’ Guide are produced together and contain most elements required by regulation. Whilst the Statement of Purpose describes the accommodation, this must also be included in the Service User Guide for potential service users, as well as the amount of fees payable. Service users’ needs are assessed by the Local Authority and given a pre-admission assessment by the home prior to admission. Service users’ have the opportunity to visit prior to admission if there are rooms available. Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 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, 8, 9, 10, 11 Service users’ needs are compromised by inadequate care plans. Consultation around care plans must be evidenced. The home must be more pro-active to promote the health care needs of service users’ with relevant professionals. Service users are treated with dignity and respect. EVIDENCE: Individual care plans were examined. The home uses two care plans, one for long term needs, one for short term and immediate needs. One long term care plan seen had no signature by the service user or their relative. This is a requirement by regulation in order to evidence consultation with service users. The inspector noted that actions identified in the more detailed short term care plan lacked sufficient detail as to the action plans required. As a result, such actions could be open to individual interpretation. This could lead to inappropriate or inadequate management of care. Actions identified must be more detailed in order to provide clear, specific instruction as to the individual treatment, care or preventative plan required, ie, the action, Mr X needs to be turned or assisted to the toilet to prevent a pressure sore from developing, must specify how often Mr X must be turned and assisted to the toilet. Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 Page 10 This must in turn be reflected and recorded in action sheets-observation notes, personal care charts or other equivalent charts evidencing actions and or treatments given. The inspector noted that the Personal Care chart in one service users’ file did not contain accurate codes to record the personal care activity undertaken. Records evidenced that service users’ are in contact with multi-disciplinary professionals. A previous complaint showed that the home must be more pro-active to promote the health care needs of service users’ with the relevant professionals. Service users’ said they were treated with dignity and respect by staff. Service users views in the event of serious illness or death have been obtained, however these forms must be signed by service users’ or their representatives. Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Service users have a variety of activities available to them to match their preferences and needs. Service users maintain contact with family and friends. The menu needs to be more varied to suit a variety of service users’ tastes. EVIDENCE: The home provides a variety of activities for service users, including movement to music, reminiscence, music provided by an independent group, board games, trips to the park in the home’s minibus. There are also visits from the local library. The inspector spoke with two visiting relatives who informed that overall they were satisfied with the service and were pleased with the care offered to their relative. One service user spoken to advised they were due to visit their relative. Another service user described herself as self-caring when ever she could manage it and that staff enable her to care for herself. The menu seen offered a variety of wholesome meals. However one service user complained of having mash potatoe too frequently. The newly recruited chef informed that the menu had been in place for some time and was due to change following consultation with service users for their views. Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 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 standard(s) 18 The home needs to evidence that it listens and, where appropriate, acts upon the views of relatives. Service users are protected from abuse, however more specific instructions are required for staff to be clear on the home’s policy and procedure in the event of a suspected abuse case. EVIDENCE: The CSCI had received multiple complaints from a relative of a service user in the home predominately concerning the care she had received in the home. Poor communication with relatives was another of the areas of complaint. The inspector investigated these complaints and found that some of the complaints were upheld or partially upheld and the others were inconclusive. Following this complaint, the Registered Manager has now introduced a form to be completed by staff to evidence significant communication with relatives. The Adult Protection Policy adopted by the home is the policy used by the Local Authority. The home must also have in place its local policy and procedure as to what the expected actions are of staff in the event of a suspected adult protection situation. Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23, 24, 25, 26 The environment is clean, safe, decorated to a homely style and is well serviced and maintained. Service users live in rooms which suit their needs. Service users have the specialist equipment they require to maximise their independence. EVIDENCE: Following a tour of the home, the inspector observed the home to be clean, tidy and hygienic. The home was bright with a homely and pleasant décor. Service users’ bedrooms were seen. Service users informed they liked, in one case “loved” their rooms. Rooms were adorned with personal possessions. The home provides a range of specialist equipment, such as hoists, parker baths, assisted showers, special beds, pressure relieving mattresses, rails, commodes and wheelchairs. The water temperature in the basin of one of the bathrooms was tested and found to be too hot. Service users enjoy a large pleasant garden at the back of the house. Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 Page 14 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, 28, 29, 30 Service users’ needs are currently being met by the numbers and skill mix of staff. Service users benefit from staff who receive training and are aware of the home’s policies and procedures. However, despite staff training and competence, issues concerning poor recording practises referred to earlier in section ‘Health and Personal Care’ can put service users’ safety at risk. EVIDENCE: Staff files were examined and found to contain all documents as required by regulations. They also contained certificates of training and induction programmes. Three staff members interviewed spoke well of the support they receive in their tasks and were pleased with the level of training they received, believing that the training was sufficient to enable them to be clear about their duties and responsibilities. Staff informed of being aware of the home’s policies and procedures and that they felt comfortable to raise issues with the Registered Manager. Team meetings take place on a monthly basis. In all there are 37 care staff and 10 qualified nurses in the home. Service users reported being well cared for by the staff, with the exception of one service user who wanted to have more time available to chat with staff. Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 Page 15 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) 31, 32, 35, 36, 37 The Registered Manager must further demonstrate their experience and competence by addressing the issues arising from this inspection and complaint prior to this inspection. Service users benefit from receiving care by staff who are well supervised and supported to carry out their tasks. Some areas of health and safety must be addressed to ensure that service users and staff are protected. EVIDENCE: Service users and staff spoken to informed that the home is run by a manager who is responsive to their needs. Staff confirmed they receive regularly supervision and supervision notes were seen in their files. The Registered Manager is in the process of completing an NVQ Level 4 course; has a diploma in Professional Studies and has significant senior management experience with this service user group. However, further to the shortfall areas highlighted, the Registered Manager must now demonstrate how her competence and experience will be used to address the serious issues identified in this report. Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 Page 16 The Registered Manager must ensure that the home has robust systems, adequate record keeping and that policies and procedures are in place and strictly observed in order to safeguard the health, safety and best interest of service users. Whilst a range of policies and procedures are in place, crucially, the home lacks policies and procedures on recording practises, particularly the use of all the home’s documentation. This is necessary to clarify procedures; to standardise and improve recording practises and to evidence observations, care and treatments given. Personal allowances were checked and found to be in order. Health and safety documents were seen and found to be in order. Some health and safety requirements are given. An electrical wiring test is now due and window restrictors are required or risk assessments in their place if not deemed to be necessary. The water in the basin of one bathroom was found to be too hot and needs adjustment to a maximum of 43 degrees. Some food found in the freezer was not covered or labelled. This was also a requirement in 2004. Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 Page 17 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 3 x x 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 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 Standard No 16 17 18 Score 2 N/A 2 2 3 N/A N/A 3 3 1 1 Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 Page 18 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 OP 7 Regulation 15 Requirement Timescale for action 30th Nov 05 2. OP 7 3. OP 7 4. OP 7 5. OP 8 The Registered Manager must ensure that all care plans are signed by service users or their representatives to demonstrate consultation with them. 15 The Registered Manager must ensure that actions recorded in service users’ care plans are outlined in sufficient detail to provide clear, specific instruction as to the treatment, care or preventative plan required, such as the frequency of turns, frequency of assistance to the toilet and any other specific care or treatment instructions. 15 Observation notes or relevant charts outlining activities undertaken must directly relate to, evidence and reflect actions specified in service users’ care plans. 12, 15 Documentation recording coded activities such as the Personal Care Chart must contain accurate codes of activities undertaken. 12, 13, 17 The Registered Manager must ensure that staff are fully aware of good nursing practices in respect of pressure sores. G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc 30th Nov 05 30th Nov 05 30th Nov 05 30th Nov 05 Manor Farm Nursing Home Version 1.40 Page 19 6. OP 8 7. OP 8 8. OP 8 9. OP 8 10. OP 8 11. OP11 12. OP 18 13. OP 38 12, 13, 17 The Registered Manager must ensure that the home has policies and procedures regarding effective recording practises for all the homes documentation, including observation notes, charts and risk assessments. 12, 13, 17 The Registered Manager must ensure that all assessment charts are updated following the identification of a pressure sore. 12, 13, 17 The Registered Manager must ensure that all communication with health professionals including decisions by them are clearly recorded. 12, 13, 17 The Registered Manager must ensure the implementation of the form devised to record all significant communication with family members. 12, 13 The Registered Manager must develop a more pro-active approach towards service users in order to promote their health and well-being, including making requests for specialist intervention where appropriate. 12 (3) The Registered Manager must ensure that documents containing service users views in the event of serious illness or death must be signed by service users’ or their representatives. 13 (6) The Registered Manager must ensure the home has in place a local policy and procedure as to what the expected actions are of staff in the event of a suspected adult protection situation. 13 (4) The Registered Manager must ensure the following health and safety requirements are implemented: 1. An electrical wiring test is due. 3oth Nov 05 30th Nov 05 30th Nov 05 30th Nov 05 30th Nov 05 30th Nov 05 30th Nov 05 30th Nov 05 Manor Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 Page 20 2. Window restrictors are required or risk assessments in their place if not deemed to be necessary. 3. The water in the basin of one bathroom must be adjusted to a maximum of 43 degrees. All food found in the freezer must be covered and labelled. 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 Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Gredley House 1-11 Broadway London E15 4BQ 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 Farm Nursing Home G57 G06 S7361 Manor Farm Nursing Home V241687 010805 Stage 4.doc Version 1.40 Page 22 - 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. 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