Inspection on 29/04/08 for Manor Farm Care Home

This inspection was carried out on 29th April 2008.

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 15/10/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Manor Farm Care Home 211-219 High Street South East Ham London E6 3PD Lead Inspector Unannounced Inspection 11:00 29th April and 1st May 2008 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.V362167.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.V362167.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 jackiec@abbeyhealthcare.org.uk 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.V362167.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. 15th October 2007 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 residents 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 residents 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.V362167.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use the service experience adequate quality outcomes. This unannounced inspection of the key National Minimum Standards for Care Homes for Older People commenced was undertaken in two days. We gathered information through speaking to residents and their relatives, as well as discussions with the registered manager, nursing and care staff, and other staff working at the care home. During this inspection we read a randomly selected sample of the care plans, checked the management of medication and residents financial records, toured the premises and looked at a selection of policies and records (such as staff recruitment, staff training and development, complaints and accident records). We conducted a Short Observational Framework Inspection (SOFI), which is a detailed observation to assess the experiences of residents with dementia. 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? Twelve requirements were issued in the previous inspection report; six of these requirements were satisfactorily met at this inspection. The service demonstrated that confidential information is securely stored and a programme of activities for people with dementia was evidenced. Staff had received Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 6 additional training from the Newham Safeguarding Adults Team and environmental improvements had been achieved (obstacles removed from the garden and measures taken to prevent shower rooms from being water logged). Senior staff had received training to provide supervision. Work had commenced upon developing the quality of the care plans and life histories, although more progress was needed. 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.V362167.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.V362167.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, 3 and 5 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 offered appropriate information about the service, and health and social care needs are suitably assessed prior to admission. EVIDENCE: We checked the Statement of Purpose and the Service User’s Guide. These documents provided information about the care home and were made available to prospective residents and their representatives. They were satisfactorily presented at the previous inspection in October 2007 and there have been no significant changes in the care home since the last inspection that would need Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 9 to be reflected in these documents. Copies of the most recent inspection report from the Commission were publicly displayed. The care plans evidenced that the needs of residents were assessed prior to admission. Although the randomly selected care plans demonstrated that people were admitted through different funding arrangements (either funded by their local social services or self-funding), all residents had received an assessment of their needs by external social and health care professionals. Through discussion with the registered manager, it was identified that any persons (or their representatives) directly approaching the care home for a self-funding placement would be encouraged to approach their local social services for a comprehensive assessment of their needs prior to proceeding with their application. We met several family visitors during the course of this inspection. We were informed that relatives had visited the care home on behalf of the resident prior to admission, as placements to the care home usually took place directly from hospital following circumstances such as acute health problems or deterioration in chronic conditions. Relatives stated that they had chosen Manor Farm as they felt it offered a homely environment. The registered manager or a senior staff nurse visited prospective residents prior to admission. Standard 6 was not applicable for assessment, as the service does not offer intermediate care. Manor Farm Care Home DS0000007361.V362167.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 service evidenced some good practices in the promotion of residents’ health and personal care needs, improvements are needed with care planning, auditing of no longer prescribed medications and delivery of essential staff training to meet residents’ health care needs. EVIDENCE: A requirement was issued in the previous inspection report for the service to improve upon the quality of the care plans. We found at the previous inspection that care plans needed to be written in a more resident focused manner that avoided unnecessary clinical terminology, so that these documents would be more accessible to residents (and/or their Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 11 representatives) and to care workers. This requirement also identified that the regular auditing of the care plans needed to be demonstrated. During this inspection we read seven care plans, which were chosen in accordance to the different circumstances of the individuals (for example, relatively newly admitted residents, people with dementia and people identified to have a pressure sore). It was noted that more recently developed care plans were now being written in a manner that did not exclude people unfamiliar with clinical terminology. The registered manager stated that she checked twelve care plans each month and the regional manager checked four care plans during the monthly-unannounced ‘person-in-charge’ visit. This requirement has now been deleted. It was noted that staff needed more guidance about the language that they used regarding residents. One care plan described a person as being a ‘nice, simple and always smiling lady’; any assessments deemed necessary for the effective delivery of care need to be phrased in a non-subjective and professional manner. We found that there was an inconsistent approach to producing care plans in a person centred manner that reflected individual preferences. For example, some care plans viewed at this inspection stated that a resident needed assistance with personal care to address their hygiene needs but there was no information regarding whether they preferred to have a bath or shower, and whether they wished for this support in the morning, afternoon or evening. We spoke to the General Practitioner for the care home, who stated that he did not have any concerns regarding the prompt reporting of relevant clinical observations or staff compliance with following medical instructions and guidance. It was stated in the previous inspection report that a concern was raised by the Newham Primary Care Trust (PCT) liaison nursing team regarding the care of a resident with pressure sores, in the week prior to the inspection. This concern was not commented upon in the previous inspection report, as it was then subject to investigation by Newham Safeguarding Adults Team. The investigation identified that the care home did not seek advice soon enough from the PCT liaison nurses team, and did not follow up a referral that they made to the Newham Tissue Viability Nurse. These actions very seriously impacted upon the safety and welfare of a resident. We were informed on the first day of this inspection that a resident had been observed by the night staff to have a new pressure sore, although this had not been properly recorded in the care plan at the time we read the document (7.30 pm on the first day of the inspection). One family stated that there had been a decline in the standard of hygiene care delivered to their relative; this concern was not identified through discussions with other visitors. Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 12 A requirement was issued in the previous inspection report for the care home to ensure that topical medications are securely stored and that medications no longer required are returned to the pharmacist. We noted at this inspection that a resident was self-medicating with a topically applied steroid cream (obtained via prescription) that they were no longer prescribed. We checked the storage and recording for medication stored on the ground floor unit; no issues of concern were noted. It was observed that although the units had been provided with valid British National Formulary (BNF) medication guides, out-of-date copies were still being displayed. Staff were advised to remedy this during the course of the inspection. A requirement was issued in the previous inspection report for the care home to ensure that confidential information is securely stored following the discovery of medically related information about a resident was displayed on a communal notice board. No issues of concern regarding the maintenance of confidential information were found at this inspection. We observed on the first day of the inspection that two members of staff took their authorised evening break in the ground floor residents’ dining room. Although the staff in question stated that residents knew and understood when staff were taking their break, we were concerned whether this would be clear to people with memory loss who might have a reasonable expectation that any care staff sitting in a prominent position within the care home were available to respond to requests for assistance. During the course of this inspection we received many positive remarks from residents and relatives regarding the polite and respectful approach of staff; we also observed good interactions between residents and staff. The PCT liaison nurses had provided ‘End of Life’ training to the Manor Farm nursing staff and there was a document that could be used for ‘End of Life’ planning. We spoke to the staff nurse on duty on one of the nursing units, who was unable to locate the document and unfamiliar with its content once it had been found, or explain the processes for ‘End of Life’ care. It emerged that the staff nurse had not been available to attend the ‘End of Life’ training. The care home does need to consider the impact of staff missing essential training and the importance of promptly arranging such training for staff, particularly taking into account the low number of registered nurses. Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were provided with a choice of activities and a food service that they enjoyed; however, improvements are needed to enable the social care for people with dementia to be delivered in a more informed way, and training is needed so that menus evolve in accordance to available nutritional guidelines and staff fully understand the menu choices. EVIDENCE: A requirement was issued in the previous inspection report for the service to ensure that life histories of residents are recorded, so that the staff can offer activities to meet individual wishes and interests. We noted that the service was working towards achieving this, although findings at this inspection have identified ways to improve upon the current practices. We chatted to two residents at lunchtime, both of who provided lively and interesting accounts of their working careers; however, this information was not recorded in their life Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 14 histories, as there was no prompt to obtain information about former occupations. We also looked at the life histories for the five residents observed during the Short Observational Framework Inspection (SOFI). Two life histories were in the process of being completed by families, and the other three required more information. For example, one life history did not record any hobbies or interests for the individual but it was noted that this person had active links with a day centre. We suggested that the activities organiser could liaise with staff at the day centre to find out if they had any useful information or observations. We found out from one of the observed residents that they liked to dance and this was confirmed by discussion with the activities organiser; however, it was not recorded. The SOFI observation was conducted over a two-hours in the afternoon. We made some positive observations during this period, which indicated that the activities staff offered appropriate activities to people with dementia. A discussion with an activities organiser afterwards demonstrated that the service has considered what kind of interventions and equipment would best meet the needs of residents with dementia in order to provide meaningful activities. Staff used items such as wind chimes, soft balls, relaxing scents and gentle music. We were informed of the use of a teddy bear but did not observe this during the inspection. We advised the registered manager and the activities organiser that the use of ‘doll therapy’ needed to be carefully researched and planned, so that relevant parties could be assured of the specific benefits that it offered to any participating residents. It was noted that the activities and care staff still had very limited training regarding dementia (three and a half hours training by the Alzheimer’s Disease Society); we found that this limited training did impact upon the quality of care provided. For example, we noted that a member of the care staff who joined the residents during the SOFI observation was keen to communicate with the residents but ‘outpaced’ people with dementia by providing too much verbal information. It was noted that residents were offered a varied selection of activities, such as board games, skittles, bingo, arts and crafts, ball games and quizzes. Outings were provided, although there was a distinct lack of outings over the winter period. We acknowledged that some residents might decline trips during the cold weather season; however, the local area does offer opportunities for indoor activities such as pub lunches and theatre shows. The care home has its own licensed bar, and residents (and their relatives) confirmed that their were regular parties and visits from professional entertainers. We observed that there were a number of visitors at the care home during the course of this inspection. People stated that they were welcomed by staff and that visiting was flexible. Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 15 We observed that residents were informed of their entitlement to advocacy services and there was an ethos of consultation and keeping people informed through the use of residents’ meetings, questionnaires and notice boards. This inspection occurred at the time of a local election; it was very encouraging to note that residents who wished to vote were supported to complete a postal form or taken out to the polling booth. We spoke to a resident on their way out to vote (assisted by a member of staff due to their mobility needs); the resident was clearly looking forward to making a contribution to their community. A requirement was issued in the previous inspection report for the registered manager to ensure that staff understand the content of the menu and for the service to evidence that the use of recognised good practice tools for the planning of the menus. We were informed at the last inspection that the registered manager and the chef were due to attend a training day regarding current good practice in meeting the nutritional needs of older people in care homes; however, neither of these staff attended due to unforeseeable circumstances. At the previous inspection it was noted that some members of staff were not familiar with descriptions on the menu plan, such as ‘Eve’s Pudding’ although these staff were responsible for explaining the menu to residents with cognitive impairments. During an observation of a suppertime on the second floor, we found that neither of the two staff present could explain what was meant by ‘Welsh Rarebit’ although this was an option for supper (which meant that staff would offer to obtain Welsh Rarebit from the kitchen for any residents that declined the available food). Residents stated that they enjoyed the food and we observed staff preparing favourite sandwiches for a few residents that did not want the items on the supper trolley; discussions with a couple of residents evidenced that the staff always offered this support. Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 16 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 relatives) are provided with systems for making complaints, although the management of complaints could be improved upon. The issues identified by the recent Adult Protection meetings have demonstrated the need for the service to ensure that the residents are protected by open and transparent recording. EVIDENCE: We looked at the complaints received on each unit since the previous inspection; the responses to these complaints indicated that issues were appropriately investigated. The use of inappropriate terminology was noted with one complaint, which stated that the resident wanted to be washed in a snap of a finger. It could not be established if this was a staff opinion or whether this was a direct statement by the resident (there were no quotation marks to evidence this). Each unit maintained its own complaints book; however, there was no documented evidence of the complaints recorded and investigated by unit staff being audited by the registered manager, or the Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 17 regional manager at monthly monitoring visits. An investigation conducted by Newham Safeguarding Adults Team since the last inspection identified that the care home did not record a complaint from relatives regarding missing jewellery. A requirement was issued in the previous inspection report for the service to ensure that staff receive rigorous and thorough Adult Protection training, so that residents are safeguarded from abuse. Newham Safeguarding Adults Team was providing this training and some staff attended this training on the second day of this inspection. The Adult Protection procedure was satisfactorily written and staff were provided with whistle-blowing guidance. There has been one Adult Protection investigation since the last key inspection. This investigation identified that staff recorded false information in a care plan about a resident (four days of activities within the care home at a time that the person was in hospital). Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 18 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): 19,21 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a comfortable, homely and clean environment; however, the safety and appearance of some communal bathrooms needs to 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. We found that a programme of re-decoration and refurbishment was being undertaken including the replacement of carpets, the painting of communal lounges and corridors and the purchase of new beds. Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 19 The lounges were observed to be very homely and residents were encouraged to personalise their bedrooms. We met a number of residents in their bedrooms, which were pleasantly decorated and maintained. It was identified in the previous inspection report that the service needed to create a more welcoming atmosphere for the hairdressing salon; the registered manager confirmed that this work would be undertaken following planned re-tiling. A requirement was issued in the previous inspection report for the service to take actions to prevent the shower rooms from becoming water logged; this problem appeared to be satisfactorily resolved at the time of this inspection. We found that a radiator frame had become dismantled and was on the floor in a communal bathroom, placing residents at risk of falls and injuries. Staff were unaware that this had occurred; unsuccessful attempts were made to rectify this problem during the course of the inspection. We also observed a significant crack in the wall of a bathroom and disintegrating tiling. The care home was observed to be clean and hygienic. Some questionnaires completed by residents and their visitors stated that there had been a notable odour on the ground floor; the registered manager stated that the cause of this problem had been identified and no offensive odours were noted at this inspection. Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 20 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. The service did not demonstrate that the skill mix of staff safely addresses the needs of the residents on the nursing care units. Effective staff training to understand the needs of people with dementia is still required, and the service needs to rigorously ensure that staff recruitment is thorough. EVIDENCE: A requirement was issued in the previous inspection report for the service to ensure that there are two trained nurses on each day shift, so that the needs of the residents will be safely met. This requirement was applicable to the ground floor and first floor units (which provide care to residents assessed to have nursing care needs) and was not met at the time of this inspection. The specific role and responsibilities of the one trained nurse on each shift were discussed in detail in the previous inspection report, such as the dispensing of 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 workers, checking that staff provided a high quality of personalised care in accordance to agreed care Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 21 plans. Other duties included formulating, updating and reviewing the care plans, liaising with external medical, health care and social care professionals, undertaking one-to-one supervisions for care workers and providing specific types of information to relatives, taking into account that care workers would not be able to provide informed comment regarding residents’ nursing care needs. This requirement has been repeated for the second time in this report and an improvement plan will be requested. The service will need to demonstrate how it meets complex or multiple care needs that are assessed to require either frequent or at least daily interventions by registered nurses. Information will be sought regarding the arrangements to enable the registered nurse on duty to take the breaks that they are entitled to, attend statutory reviews for residents, participate in training and staff meetings, provide induction training for new staff and deliver a minimum of six formal one-to-one supervisions each year to the designated care staff that they are responsible for supervising. We received a number of comments from relatives that commented upon how busy staff appeared. One relative stated, “the day staff are marvellous but rushed off their feet”. A recorded complaint from a relative commented upon the untidiness of a resident’s bedroom and questioned why this was not observed and dealt with. The explanation from staff was that they were too busy checking in the monthly medication. We looked at the service’s training for staff. It was noted that care staff were able to access National Vocational Qualifications in Care at levels 2 and 3. A requirement was issued in the previous inspection report for the service to provide training for staff in the care of people with dementia. It was noted at the last inspection that the registered manager was planning to undertake a ‘train the trainer’ course in dementia; this had not occurred at the time of this inspection. Evidence was produced to demonstrate that staff had attended a three and a half hours training course in dementia provided by the Alzheimer’s Society; discussion with the registered manager identified that this was not an appropriate level of training for either registered nurses or care staff. It was agreed that staff would need dementia care training equivalent to at least three days. As staff did not have up-to-date individualised training records, it was difficult to establish if all staff had attended the mandatory training required for their role and responsibilities. We checked two files to ascertain whether recently appointed staff had received induction training; records to evidence this training were found. We looked at four staff recruitment files during this inspection. The following observations were made: Staff recruitment file 1 This file was for a care worker. The person had returned to employment at the care home having not worked at the establishment for one year and five months. The references within the file had been sought for the first period of Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 22 employment, hence there was no detailed verification of the person’s activities and conduct in the seventeen months that they had not been employed at the care home. Staff recruitment file 2 This file was for a care worker. The first reference was from the previous employer, who had employed the candidate for one year but the second reference (a personal reference) was from a referee that had known the candidate for only three months. Staff recruitment file 3 This file was for a staff nurse. There were two professional references from overseas; however, the staff nurse had worked as an adaptation nurse for six months at another care home in the United Kingdom before commencing at Manor Farm but there was no reference was sought from the care home. Staff recruitment file 4 This file was for a staff nurse. There was no information on the candidate’s application form to explain their activities (for example, employment, study, leave from employment for family reasons) between 2000 and 2003. There was no evidence to indicate that this gap in employment had been explored. There was no written documentation of the questions asked and responses received at recruitment interviews. The need for this evidence was discussed with the registered manager at this inspection. Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 23 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The views of residents (and their representatives) are sought for the development of the care home, although the monitoring visits reports need to demonstrate a more in-depth scrutiny of the quality of the service. The need for staff to receive supervision from suitably trained supervisors had been addressed; however, the safety of the residents needs to be consistently adhered to. EVIDENCE: Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 24 The registered manager is a registered general nurse and has a management qualification. We received some very positive remarks from residents and relatives during the course of this inspection, stating that they were very pleased with the conduct of the staff and they enjoyed the homely atmosphere provided by the service. Findings at this inspection, and the previous inspection, have identified areas of practice that need to be robustly addressed by the registered manager and the registered provider. Although the care home has a dementia care unit accommodating thirty-two residents, none of the staff, including the registered manager, possessed adequate training in dementia care. Staff recruitment did not evidence suitable practices to ensure the safety of vulnerable residents. We looked at the care home’s systems for assessing the quality of its service, including approaches to seeking and acting upon the views of the residents and their representatives. It was noted that the care home conducted meetings with residents and issued questionnaires to residents and relatives; the general feedback found on the sample of questionnaires viewed at this inspection indicated that people were pleased with the service. The service produced monthly reports by the regional manager, following the monthly-unannounced ‘person-in-charge’ visits. It was noted that very similar observations were made each month and there did not appear to be a transparent and in-depth analysis of the issues of concern identified at this report; for example, an auditing of the complaints should have highlighted the inappropriate terminology written by staff in January 2008 or reflections questioning the absence of community based activities during the winter months. We spoke to a member of the administrative staff and looked at the processes for managing residents’ own finances. Written and computer records were produced, which evidenced that different checks were made to ensure that individual balances were correct. At the time of this inspection the service was managing the personal spending allowances of twenty-five residents and receipts were maintained to demonstrate how residents spent their allowances. A requirement was issued in the previous inspection report for staff with a responsibility for providing supervision receive training for this role. Four senior staff were noted to be attending a six-month management course provided by Skills for Care, which addressed staff supervision. We looked at the supervision records for four members of staff (two staff nurses and two care-workers) and found that supervision was being provided every two months. The service had introduced a new supervision form, which was noted to be more comprehensive than the previous format. Evidence was provided to demonstrate that staff meetings were conducted. The following health and safety records were checked during this inspection and found to be satisfactory: (1) weekly water temperatures (2) annual landlord’s gas safety certificate (3) annual portable electrical appliances testing (4) professional maintenance of fire alarms and (5) inspection of electrical Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 25 appliances by a competent person. We found that one resident had cleaning fluids and products in their en-suite toilet containing chemicals that would be harmful if inappropriately accessed by a person with dementia. The registered manager stated that their family had brought in these items; it was not known how long the items had been in the toilet or why staff had not observed and addressed this issue. The staff changing room and a sluice room were not locked and could be accessed by residents with dementia and confusion. The risk of confused residents accessing potentially harmful items in the changing room (such as prescribed medication within a coat pocket) or sustaining injuries by tampering with equipment in the sluice was discussed with the registered manager. Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 26 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 ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 Standard No 19 20 21 22 23 24 25 26 Score 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X 2 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13(2) Requirement The Registered Manager must ensure that medications that are no longer required are returned, so that residents are protected from unnecessary risks to their safety and welfare. This is a repeated requirement. 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. This is a repeated requirement. The service needs to introduce a system, such as descriptions on menu plans. Valid training for the chef/other relevant persons regarding Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 28 Timescale for action 30/06/08 2. OP15 16(2) 31/10/08 3. OP27 18 (1) (a) 4. OP29 19 (5) 5. OP38 13 (4) (a) 6. OP30 18 current good practice guidelines for meeting the nutritional needs of older people needs to be evidenced. The Registered Manager must evidence in the improvement plan how the service is able to meet the specialist nursing needs of the residents on the ground and first floors, in response to the issues of concern identified in this report. The requirement for increased trained nursing staff in the previous inspection report was not met. This is a repeated requirement. The Registered Manager must ensure that the rigorous recruitment of staff is conducted, in order to promote the safety of the residents. The Registered Manager must ensure that residents do not have access to sluice rooms and staff changing rooms. The Registered Manager must ensure that staff receive the training that they needs for their roles and responsibilities. This includes an appropriate level of training for dementia. 31/08/08 31/08/08 30/06/08 31/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Manor Farm Care Home DS0000007361.V362167.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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.V362167.R01.S.doc Version 5.2 Page 30 - 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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