Inspection on 15/10/07 for Manor Farm Care Home

This inspection was carried out on 15th October 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Manor Farm Care Home 29/04/08

Manor Farm Care Home 02/10/06

Manor Farm Care Home 07/11/05

Manor Farm Care Home 01/08/05

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 Care Home 211-219 High Street South East Ham London E6 3PD Lead Inspector Sarah Greaves Unannounced Inspection 10:30 15 , 16th & 29 October 2007 th th 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 Care Home DS0000007361.V354078.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 Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor Farm Care Home Address 211-219 High Street South East Ham London E6 3PD 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) 020 8548 8686 020 8548 9929 Trees Park (East Ham) Limited Jacqueline Bridget Philomena Connolly Care Home 81 Category(ies) of Dementia (81), Old age, not falling within any registration, with number other category (81) of places Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is 81. 2nd October 2006 2. Date of last inspection Brief Description of the Service: Manor Farm is one of a group of care homes run by Trees Park (East Ham) Ltd. It is a purpose built dual registered residential and nursing home. It is registered to take 81 elderly service users over the age of 65 years with dementia care needs, general residential and general nursing care needs. The home is divided into three units. The top floor is residential while the ground and first floor units are for service users with nursing needs. There are single and double rooms, all with en-suite facilities. The home is situated in East Ham, close to shops and local amenities with good access by public transport. Parking facilities are available in the front of the building. Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors conducted an unannounced inspection of this service on Monday 15th October 2007. The inspectors gathered information by speaking to residents, relatives, the registered manager and staff. The inspectors toured the premises, checked the management of medication and residents’ finance records, and read eight care plans. The inspectors joined residents for lunch on the first day of the inspection. One inspector returned to the care home on Tuesday 16th October in order to check staff files (recruitment, training and supervision), read policies and procedures, and assess the quality of recreational activities. Further information was sought from social care professionals following the two-day visit to the care home. The Commission for Social Care Inspection issued an Annual Quality Assurance Assessment (AQAA) to the care home several weeks prior to this inspection. The information provided within the AQAA has been used within this report. What the service does well: What has improved since the last inspection? Eleven requirements and five recommendations were issued in the previous inspection report; nine of the requirements and all of the recommendations had been met. The care home demonstrated that improvements had been made to its quality assurance systems and improvements had been achieved with the maintenance of the premises. The staff recruitment files now contained required health information. The care home kept residents and visitors informed of activities and other news through the use of notice boards in the front entrance. Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 6 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 Farm Care Home DS0000007361.V354078.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 Farm Care Home DS0000007361.V354078.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): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents (and their representatives) are provided with suitable information about the care home and their holistic needs are appropriately assessed. EVIDENCE: A recommendation was issued in the previous inspection report for the care home to separate the Statement of Purpose and Service Users’ Guide. The inspectors found that the care home had created its own ‘Welcome Handbook’ for residents and their representatives, which was offered to prospective residents in conjunction with the Statement of Purpose and Service Users’ Guide. The inspectors were satisfied that the care home provided Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 9 comprehensively presented information to assist people find out about its objectives and services, hence this recommendation has been satisfactorily met. The inspectors read eight care plans during this inspection. It was noted that residents had received a thorough assessment of their needs prior to admission. The care home undertook its own assessment as part of the care planning process. Standard 6 was not applicable for assessment, as the care home does not offer intermediate care. Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10 and 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the care home demonstrated some positive practices in the planning and delivery of health and personal care, more attention must be applied to the content and presentation of the care plans. Staff knowledge of medication was good; however, measures to ensure the safe management of topically applied medications must be ensured. Residents need to be assured of a consistent approach to promoting their dignity. EVIDENCE: A requirement was issued in the previous inspection report for the care home to ensure that accurate scoring systems were used for care plan assessments and to ensure that a consistent approach was demonstrated with the identification of care planning objectives (for example, a resident deemed to Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 11 require support with mobilising in their short-term care plan assessment should be provided with a more detailed care plan to address this need within the main section of their care plan). The inspectors read eight care plans; five of these care plans were for residents that required nursing care and three of the care plans were for residents that needed residential care. Several of the care plans were well written, with very thorough assessments and a detailed level of nursing knowledge was demonstrated. The care plans addressed the health and social care needs of individuals and used recognised tools for assessing clinical issues such as skin integrity, nutrition and risk of falls. The inspectors noted that there were a few inaccurate findings within the clinical assessments. The Body Mass Index (BMI) for one resident was recorded as 18; however, the correct score was 19. In accordance to the care home’s own procedures a score of 18 should have triggered a referral to a dietician; however, there was no evidence to indicate that this had occurred. Another resident was placed in the wrong age category on a clinical assessment for skin integrity, which meant that their score was one point too low. The inspectors were concerned that discrepancies of this nature could lead to staff failing to identify that an increased level of monitoring and interventions might be required. The inspectors spent some time looking at the falls risks assessments (issued by the Primary Care Trust) with a staff nurse, including cross-referencing the medications listed on the assessments with the residents’ medication charts and the British National Formulary (BNF) medication guide. Upon discussion with the registered manager, the inspectors were informed that the care home no longer used the PCT assessments as they had their own version, but the obsolete assessments had not been removed from the care plans. The inspectors observed that the care plans now demonstrated that the needs of the residents within the short-term assessments had been transferred to the long-term assessments (unless it was demonstrated that an initially assessed need had now been resolved). The care plans were noted to contain some inappropriate abbreviations and terminology, taking into account that these documents should be accessible to residents and/or their relatives, and to the care assistants. The inspectors acknowledged that staff must record within the admission notes that a resident has been diagnosed with hypertension, for example; however, a specific care plan to support the resident to safely manage their daily activities could explain that they have high blood pressure and how this impacts upon their social and domestic routines. Another care plan stated that a person had ‘neuromuscular impairment 2o to CVA’ rather than describe how the person’s movements had been affected, secondary to having had a stroke. Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 12 The registered manager stated that she audited a sample of the care plans every month, although there were no records within the care plan or separate records in the office to indicate which care plans had been checked. Via discussion with the registered manager, the inspector was informed that the care home had a good working relationship with the General Practitioner (GP) service. The care home received weekly visits from the Newham Primary Care Trust Continuing Care Nurses and accessed other health care services as required (for example, chiropody and dental care). The inspectors noted that one care plan identified that a resident had been identified as having problems with swallowing in September 2007 and a care plan to address this need was established. It was noted that the GP had prescribed a nutritional supplement in October 2007; however, this information had not been transferred into the care plan. The registered manager stated that the care home used guidance from the Primary Care Trust and the National Institute for Clinical Excellence (NICE) guidelines for managing pressure sores. The registered manager stated that staff had undertaken training provided by the local Tissue Viability Team. Concerns regarding the service’s care of a resident with pressure sores was raised by the visiting Primary Care Trust continuing care nurses in the week prior to this inspection; this resident had been sent to hospital. The inspectors enquired whether there were any residents with pressure sores at the time of the inspection and were told that there were none. During a random selection of care plans on one of the units the inspectors found a care plan for a resident with a Grade 2 pressure sore; however, the staff nurse on duty stated that it was a Grade 1 pressure sore. Upon discussion, the inspectors were notified that the pressure sore had been dressed by the staff nurse on night duty, who verbally informed the day duty staff nurse that the pressure sore had now improved to a Grade 1. The inspectors looked at the written entry in the daily records, which confirmed that a dressing had occurred during the night shift; however, there was no written information to confirm that this significant change had occurred. The inspectors raised this finding with the registered manager, who stated that she had been informed that morning that the resident had a Grade 1 pressure sore, which was not identified to the inspectors because the skin was not broken. The inspectors anticipated being informed of any pressure sores, irrespective of the classification. The inspectors checked the storage and recording of medications on the residential unit. Senior care workers managed the medication needs of the residents on the residential unit. The inspectors were impressed with the knowledge of medications demonstrated by the senior care worker on duty. The medication policy was satisfactorily presented. A requirement was issued in the previous inspection report for a) Medication found in residents bathrooms, including creams, must be stored in cabinets for safe storage and Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 13 b) Prescribed medications, such as E45 cream, must not be transferred for use to other residents once the cream is no longer required by the resident originally prescribed for. All disused medicines must be returned to the pharmacist. The inspectors found that prescribed topical creams were kept in residents’ bedrooms in drawers so that confused residents could not access these items. However, the inspectors observed that a resident had removed their prescribed creams from the drawer and one of these items was no longer prescribed for the person. This observation has identified the need for the care home to change their current practice; prescribed treatments should be stored in a lockable facility and staff must be more vigilant in removing discontinued medications. No evidence was found to indicate that residents were being given medications originally prescribed for another person. One visitor informed the inspector of an occasion when their relative did not receive a prescribed medication for several days because the supply ran out. The relative questioned why staff had not re-ordered the medication when the supply was dwindling. All of the units had an up-to-date medication guide. Residents and their relatives expressed positive views about the staff and the way that they were cared for. The inspectors were told that staff were helpful and hard working, which was also observed by the inspectors. It was noted during lunchtime that one member of staff consistently addressed residents by terms of endearment although the colleague working with this person spoke to the residents using their preferred way of being addressed. The inspectors noted on the second day of the inspection that an inappropriate selection of music was being played to the residents in a communal lounge. The inspectors spoke to the member of staff responsible for selecting the compact disc, who that the music had been chosen ‘to liven them (the residents) up’. The inspectors brought this compact disc to the registered manager, who agreed that it was inappropriate and evidenced that the care home owned a wide selection of music that had been carefully chosen to meet the interests and wishes of the residents. The inspectors observed that a letter from a dietician was displayed on a communal notice board in the ground floor dining room with instructions for thickening the food of a resident, with the name of the resident evident to other residents and visitors. The inspectors notified the registered manager of this finding. The inspectors were informed that ‘End of Life’ training was being delivered to staff by one of the Primary Care Trust Continuing Care nurses. The registered manager stated that the two GP’s that provided a medical service to the care home were supportive of the residents entitlement to choose their preferred place of care for their final care needs. The inspectors would expect to find more detailed information within the care plans, including documentation of discussions with residents and/or their representatives, once staff have completed their training. Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefited from the care home’s activities resources, including the transport service to promote community- based activities. However, specific support to meet the needs of people with dementia must be demonstrated. Residents were supported to make choices. Some improvements are needed to the food service to evidence that specialised diets are effectively met and staff knowledge of the menus must be promoted, to support residents to access food that they enjoy. EVIDENCE: The inspectors met with the home’s activities co-ordinator, who worked with one other member of staff. The activities co-ordinator had undertaken a National Vocational Qualification level 3, which was specifically for activities. The records provided indicated that the care home offered a wide range of Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 15 leisure opportunities such as skittles, bingo, singing, dancing, puzzles, board games, watching films and a licensed bar. The home owned a minibus; outings were offered on Wednesdays and Fridays. Residents were offered opportunities to attend local summer concerts, take day trips to places of interest and meet people at community resource centres in Newham, including a Chinese day centre. The inspectors noted that the activities records did not specifically state how the activities and care staff addressed the needs of people that were unable to or did not wish to take part in group orientated activities (for example, by offering one-to-one discussions or supporting a resident to engage in a favourite activity such as looking after plants or reading). The inspectors also found that there was no separate plan for meeting the needs of the residents with dementia, although the activities co-ordinator stated that some of the activities such as skittles and singing were provided on the unit for people with dementia. The inspectors acknowledged that these were appropriate activities for people with dementia; however, the activities organiser should be able to demonstrate that a broad range of activities are offered to these residents, including the use of sensory equipment and therapeutic interventions. The inspectors were informed that an external reminiscence therapist visited the home once a fortnight but there was no evidence to suggest that staff had been trained to facilitate reminiscence style activities in-between these visits. It was noted in the care plans that the staff did not gather information about residents’ life histories, which was particularly important for residents that were unable to talk to staff about their former occupation, childhood or hobbies because of current cognitive and/ or physical frailties. Apart from the fortnightly visit from the reminiscence therapist, the care home did not evidence any links with organisations that advise upon good practice for people with dementia. A recommendation was issued in the previous inspection report for the care home to display a programme of forthcoming activities and entertainments on a prominently placed notice board; this recommendation was met. Through speaking to residents, relatives and the registered manager, the inspectors found that the care home offered flexible visiting. Relatives stated that they felt welcomed whenever they visited and they were offered refreshments. The minibus had been used to take residents to the homes of relatives, which was considered to be good, creative practice to meet peoples’ individual needs. The inspectors noted that the care home displayed information regarding how to contact advocacy services. The care plans viewed by the inspectors evidenced that residents had received annual reviews by their placing authorities, which explored whether people were offered choices. Although a significant number of residents were either diagnosed with dementia or had some degree of cognitive impairment, the inspectors met some residents with physical health problems who were able to clearly articulate their views. The Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 16 information provided by these residents was very encouraging. One resident enjoyed entertainments in her room (films and reading); this resident felt that staff respected her choices and encouraged her ability to make decisions regarding daily routines. The inspectors joined the residents on the ground floor unit for lunch on the first day of the inspection. The inspectors sat at different tables; however, both inspectors found that the salt and pepper pots were empty. Residents were offered two choices at lunchtime; additionally ‘off menu’ selections were prepared by the chef. The inspectors asked several care staff which meat was used for the shepherds’ pie and found that care staff had to refer this question to the chef. The inspectors noted that a dessert called ‘Eve’ s pudding’ had been served on the previous day; once again, none of the staff could state what this was. The inspectors spoke to the chef who was familiar with cooking international foods and suitable ingredients (such as yams, rice and noodles) were available. The registered manager stated that the chef and herself had been booked to attend a training course offered by the Royal Institute of Public Health. The inspectors looked at the contents of the training day, which addressed how to meet the nutritional needs of older people in care homes. The inspectors had noted that although the current menu clearly demonstrated that good practice was being applied (for example, two vegetables at main meals, fresh fruit and home-baked cakes and sponges) the menu planning needed to specifically show that the needs of the more vulnerable residents were being addressed (such as people with dementia who might not eat well or people that needed higher calorie diets to repair damaged skin). Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents (and their representatives) are assured that their complaints will be appropriately investigated. Although the care home provided Adult Protection training, the quality of the internally provided training needs to be improved to ensure that staff fully understand their responsibilities. EVIDENCE: The inspectors looked at the care home’s complaints procedure and the complaints log. It was noted that the complaints procedure was satisfactorily presented and no issues of concern were identified regarding the investigation of complaints. The registered manager was advised to use a more straightforward recording system to clearly show when a complaint was resolved. A recommendation was issued in the previous inspection report for the care home to provide a comments book, which should be displayed in a prominent place. This recommendation was met. The Adult Protection policy (inclusive of whistle-blowing) was satisfactorily written. Staff were provided with Adult Protection training by Newham Safeguarding Adults Team in May 2006 and the care home provided its own Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 18 training through using a training video. The inspectors spoke to a staff nurse regarding her knowledge of Adult Protection procedures. The inspectors were concerned that the staff nurse could not identify that Newham Safeguarding Adults Team took the lead role in the investigation of Adult Protection concerns; the staff nurse stated that this was the role of elected councillors. The inspectors were concerned regarding the quality of the training provided by the video, which has been the only option for staff appointed after May 2006. One of the staff files contained a written test completed by a staff nurse after watching the video. In response to a question regarding which people or agencies could give a worker advice about abuse or reporting abuse, the response was the Commission for Social Care Inspection and ‘policies’, which the inspectors considered to be an inadequate response by a member of staff who supervises care workers. Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were provided with pleasant bedrooms and communal lounges; however, the safety of the outdoor areas and bathrooms must be improved. EVIDENCE: Manor Farm is a purpose built care home with accommodation on the ground, first and second floor. There is a passenger lift, and a residents’ garden at the rear of the premises. Five requirements relating to the environment were Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 20 issued in the previous inspection report. A requirement was issued for the care home to a) Store hoists more discretely b) Ensure that laundered sheets were not left in bathrooms c) Ensure that the bathrooms are more homely. This requirement has been met, although the inspectors felt that there was scope to add more homely touches to the bathrooms. The inspectors observed that laundered clothes had been left in a small communal lounge; a nearby-disused cupboard was suggested as a more appropriate alternative. A requirement was issued for the registered manager to ensure take actions to prevent the ground floor from becoming water logged. Although this shower room appeared to be satisfactory, the inspectors found that other shower rooms were water logged; therefore this requirement has been repeated. The remaining three requirements (repair of a communal toaster, re-decoration of torn wall paper and cleaning of the floor on the residential unit) were met. The inspectors toured the premises at this inspection visit. It was noted that discarded items had been left in the garden, including a plank of wood, parts of a wheelchair and opened tins of paint. The inspectors observed that the lounges were homely, with individual pieces of furniture and cabinets with ornaments. The small lounges created the ambience of being within a pleasantly maintained domestic property. However, the inspectors noted that a Christmas tree had been put up in a small lounge and there was also a cabinet full of china and porcelain Christmas figurines. The inspectors asked a staff nurse why there was a Christmas tree on display in mid-October and were told that it was to prepare residents with dementia for Christmas, which was considered by the inspectors to be inappropriate practice. The hairdressing room needed to be re-tiled (this work was planned) and then decorated to create a welcoming environment. The residents’ bedrooms were satisfactorily maintained. Many of these rooms had been personalised by relatives and friends. The inspectors found the premises to be clean and free from any offensive odours. The Commission had received information earlier this year from a social worker regarding concerns about cleanliness at the care home. The inspectors spoke to one of the housekeeping staff about their duties and were satisfied that suitable arrangements were in place for the cleaning of communal areas and bedrooms. Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 21 Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 22 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): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected through safe staff recruitment; however, the needs of residents must be addressed by increased trained nursing care during the day and more in-depth staff training. EVIDENCE: The inspectors identified some concerns regarding the staffing skill mix. There were twenty-six residents on the ground floor (general nursing care); one registered nurse and four care workers were employed between 8am and 8pm. Thirty-two residents, with a diagnosis of dementia, resided on the second floor, which was staffed by one registered nurse and six care workers from 8am to 8pm. Twenty-three residents that required general residential care occupied the second floor; three senior care workers between 8am and 8pm staffed this unit. The inspectors felt that the registered provider must carefully review the presence of only one trained nurse per day shift. The trained nurses took responsibility for dispensing medications in the morning, lunchtime and early evening, in addition to addressing other medication needs throughout their shifts. The trained nurses were also responsible for managing a team of care Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 23 workers, ensuring that staff provide a high quality of personalised care in accordance to agreed care plans. Additional duties included formulating, updating and reviewing the care plans, liaising with external professionals, undertaking one-to-one supervisions for care workers and providing information for relatives, taking into account that care workers would not be able to provide comments regarding specific health issues. The inspectors were unable to ascertain how the trained nurses were able to spend sufficient time undertaking essential daily observations of residents, particularly for people who were susceptible to infections, pressure sores and other health conditions. During this inspection there were no incidences of residents becoming acutely unwell but such occurrences would mean that the trained nurse would need to spend considerable time with a resident (for example, undertaking clinical observations and making a person comfortable until an ambulance arrived). The inspectors were of the opinion that a minimum of two trained nurses must be rostered on each day shift to ensure a safe and supportive environment. The staffing levels and skills mix for the residential unit and for night duties were found to be acceptable, although the registered manager should review these arrangements if the dependency needs of residents increases. Staff in charge of units were provided with a paid fifteen minutes hand-over period. At the time of this inspection the care home employed six adaptation nurses, who were attending City University in order to gain UK nurse registration. These staff worked thirty-six hours per week as care workers. The inspectors found that the care home used training videos for topics including Adult Protection and basic life support. The inspectors’ thought that staff should be required to practically demonstrate their understanding of emergency airway management before being issued with a basic life support certificate, as completing a questionnaire after watching a video does not indicate how staff might respond to a recognisably stressful event. The registered manager stated that she was planning to undertake a ‘train the trainer’ course in dementia, although no arrangements had been made at the time of this inspection. Some staff had accessed one- day courses from Newham Social Services (mental health awareness, dealing with aggression, and the Mental Health Capacity Act); however, the inspectors were concerned that the care home had not yet provided a programme of dementia care training for nursing and care staff, taking into account that thirty-two residents were stated to have dementia. The findings within this report (for example, no structured daily programme of activities for people with dementia and the inappropriate early use of a Christmas tree as a reality orientation tool) have demonstrated that staff need training. Through looking at staff files, the inspectors found that staff received mandatory training such as fire safety, manual handling, food hygiene and infection control. Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 24 A repeated requirement was issued in the previous inspection for the registered manager to ensure that all staff produced a statement of their mental and physical fitness. The inspectors checked four staff files and found that this requirement was met. Recruitment practices were in accordance with the stipulations of the National Minimum Standards and Regulations for Older People. The staff files demonstrated that staff accessed National Vocational Qualifications (NVQ) in Care and newly appointed staff were provided with a six week structured induction programme. The induction documents within staff files indicated that the content of the course was appropriate. Senior care workers had attained NVQ level 3. Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents (and their representatives) are assured that their views are used for the improvement of the service, personal finances are correctly managed and that the safety of equipment is maintained. The registered manager needs to ensure that staff receive appropriate supervision from people who are trained for this role. EVIDENCE: Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 26 The registered manager is a registered nurse and has a management qualification. Findings at this inspection have identified some positive management approaches, such as the opportunities for residents to integrate within the local community, safe staff recruitment and the pleasing remarks made by residents regarding flexible and relaxed routines. However, other issues have identified the need for the registered manager to recognise and address the quality of staff supervision and training, and the need for increased trained nursing presence during the day. A requirement was issued in the previous inspection report for the registered manager to improve upon the care home’s quality assurance systems. The care home demonstrated that the views of residents and relatives were sought in order to achieve improvements. The care home conducted surveys as well as holding meetings. A recommendation for the care home to display notices about forthcoming residents meetings was met. Relatives stated that they felt confident that they could speak to the registered manager and staff if they were not happy with any aspect of the service, and their views would be responded to. The inspectors checked the care home’s management of residents’ finances with the administrator. No issues of concern were identified with the systems used. The inspectors checked the supervision records for four staff members. It was noted that staff received regular supervision; however, the quality of the supervision was variable. Although some good examples of supervision were found, the inspector observed that the supervision for a care worker was completely unsuitable. The supervision covered one area of practice only, although the care home has now introduced new templates to ensure that issues such as training and development will be discussed. The supervision for the care worker addressed wound healing and contained numerous entries such as how to promote haemostasis, inhibit or kill microorganisms and apply flexible hydrocolloid dressings. Following lengthy discussions, the registered manager acknowledged that this was not an appropriate type of supervision for a care worker, who actually needs to know about the practical care for a person with a pressure sore, such as checking that the dressing is intact, that the pressure relieving mattress is functioning and that guidance within the care plan for regular changes of position is adhered to. It was noted that one member of staff had written out their own supervision about different routes of drug administration, which looked like information from a textbook. The registered manager stated that senior staff had received training in how to deliver supervision; however, this training was not documented in staff files. A requirement was issued in the previous inspection report for the care home to introduce a more effective system to identify when maintenance checks by external contractors are due, which was met. The inspectors looked at a Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 27 sample of the health and safety records, which were satisfactory (gas safety, hoist checks, electrical wiring check by a competent person, portable electrical appliances testing, pest control, refrigerator and freezer temperatures, and water safety tests). Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 2 X X 3 X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 Requirement The Registered Manager must ensure that care plans are written in a resident focused manner, avoiding unnecessary clinical terminology, so that these documents can be understood by residents and/or their representatives and easily followed by care workers. Timescale for action 29/02/08 2. OP9 13 (2) The Registered Manager must ensure that the care plans are regularly audited and documentation of the auditing process must be provided. The auditing must include looking at the quality and accuracy of clinical assessments. The Registered Manager must 15/12/07 ensure that topical medications are securely stored and that medications that are no longer required are returned to the pharmacist, so that residents are protected from unnecessary risks to their safety and welfare. This is a repeated requirement. The Registered Manager must DS0000007361.V354078.R01.S.doc 3. OP10 12 (4) (a) 15/12/07 Page 30 Manor Farm Care Home Version 5.2 4. OP12 16 (2) (m) 5. OP12 15 6. OP15 16 (2) (i) ensure that confidential information is securely stored, so that the dignity of residents is promoted. The Registered Manager must 31/01/08 ensure that a programme of activities is developed for people with dementia and for people that choose and/or require oneto-one activities, so that the recreational needs of all residents can be addressed. The Registered Manager must 29/02/08 ensure that the life histories of residents are recorded, so that the staff can offer activities to meet individual wishes and interests. 15/12/07 The Registered Manager must ensure that staff receive guidance regarding the daily menu options, so that residents can be supported to make informed choices. The Registered Manager must ensure that the menu planning demonstrates that good practice for meeting the nutritional needs of older people has been utilised, so that residents are offered healthy choices to meet specialised needs. The Registered Manager must 31/01/08 ensure that staff receive rigorous and thorough refresher training in Adult Protection, so that the residents are safeguarded from abuse. The Registered Manager must 15/12/07 ensure that unnecessary obstacles are removed from the garden, so that residents can enjoy a safe environment. The Registered Manager must 31/12/07 ensure that actions are taken to prevent the shower rooms from becoming water logged. DS0000007361.V354078.R01.S.doc Version 5.2 Page 31 7. OP16 13 (6) 8. OP19 23 (2) (o) 9. OP21 23 (2) (b) Manor Farm Care Home 10. OP27 18 1 (a) 11. OP30 18 (1) (c) 12. OP36 18 (1) (c) This is a repeated requirement. The Registered Manager must 31/12/07 ensure that there are two trained nurses on each day shift, so that the needs of the residents will be safely met. The Registered Manager must 29/02/08 ensure that staff receive training to meet the needs of residents with dementia. The Registered Manager must 31/12/08 ensure that staff with a responsibility for providing supervision receive training for this task, so that residents benefit from receiving care from well-supported staff. 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 OP30 Good Practice Recommendations Staff should evidence their competency to provide basic life support through practical demonstrations during their basic life support training. Manor Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Farm Care Home DS0000007361.V354078.R01.S.doc Version 5.2 Page 33 - 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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