Inspection on 07/11/05 for Manor Farm Care Home

This inspection was carried out on 7th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Manor Farm Care Home 29/04/08

Manor Farm Care Home 15/10/07

Manor Farm Care Home 02/10/06

Manor Farm Care Home 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 Nursing Home 211-219 High Street South East Ham London E6 3PD Lead Inspector Nurcan Culleton Announced Inspection 7th November 2005 10:00 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 Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 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 Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Manor Farm Nursing Home Address 211-219 High Street South East Ham London E6 3PD Telephone number Fax number Email address 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 - over 65 years of age (58), Old age, registration, with number not falling within any other category (23) of places Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 32 BEDS ELDERLY MENTALLY ILL PERSON - NURSING 26 ELDERLY FRAIL NURSING 23 ELDERLY FRAIL - RESIDENTIAL MINIMUM STAFFING NOTICE Date of last inspection 1st August 2005 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 mental health needs; residential and nursing care needs. The home is divided into three units. The top floor is residential while the ground and first floor units are for nursing needs. The accommodation is spacious, comfortable and well furnished and there are front and back gardens. There are single and double rooms, all with en-suite facilities. The premises 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 Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on 07th November 2005. The Registered Manager and Regional Manager were present to assist with the inspection. This report is based on the outcome of the inspection following interviews with the Registered Manager and Regional Manager, four service users, four staff members; a tour of the premises and examination of records and documentation such as service users and staff files an policies and procedures. The last inspection took place on 01st August 2005 and prior to this the CSCI had investigated a complaint made by a relative. The inspection resulted in 13 requirements being made, taking into account the outcome of the complaint and principally concerned the quality of care plans and assessments used in the home. This inspection reviewed these requirements and examined whether progress has been made since the last inspection. There were 80 service users residing in the home at the time of the inspection and one vacancy. What the service does well: What has improved since the last inspection? There has been significant progress in response to the outcome of the last inspection. All 13 requirements made at that inspection were met with satisfaction. This principally concerned the quality and recording of information in care plans and other associated documents such as risk assessments. The Registered Manager has developed comprehensive policies and procedures setting out standards and expectations for staff on how to produce care plans, assessments and other records in service users’ files. The Registered Manager has also provided training for all staff in line with these policies and procedures. The result has been a noticeable improvement in the quality of care plans produced by staff, assessments and general records found in service users’ files. Other improvements include the introduction of new forms to evidence communication and action taken by health professionals, such as the Tissue Viability Nurse; a separate form for the G.P and the recording of significant communication with relatives, meeting another requirement made at the last inspection. These improvements have raised standards in the home, improving overall practice and service delivery. The effect is that increased safeguards are in Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 6 place to promote and protect the health, safety and well-being of service users. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 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 Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5, 6 Service users are made aware of the homes’ terms and conditions in writing. Service users and their relatives are able to visit the home and are assured that their needs are assessed prior to their admission. Service users can be confident that their needs can be met by the home. EVIDENCE: A requirement was given at the last inspection for the home to ensure it improves its service users’ contracts. The contracts were revised and contained all required elements. The home assesses service users’ needs prior to their admission through a pre-admission assessment after receiving assessments from the Local Authority. Service users confirmed that they or their relatives were able to visit the home. Assessments viewed by the inspector were satisfactory covering a range of service users’ needs to form a basis for the development of the homes’ individual care plans. The home does not provide intermediate care. Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 The home has made significant progress towards ensuring that the health, personal and social care needs of service users are set out in individual care plans and that actions are identified and specified in care plans to meet assessed needs. Service users will benefit from the homes’ improved policies and procedures, setting out the framework for good practise and improving expected standards of service delivery. EVIDENCE: The inspector reviewed the 10 requirements issued to the home at the last inspection concerning the quality and recording of care plans and assessment tools used to identify needs. The inspector observed much improvement in the recording of care plans and assessments, including risk assessments. The Registered Manager had developed detailed guidance, policies and procedures, as required at the last inspection, to inform staff and set standards on the development and recording of documentation, in particular, care plans and risk assessments, ensuring that needs identified in risk assessments are linked with needs specified in care plans. Care plans and risk assessments were reviewed, as required, following changes in service users’ needs. The Registered Manager has ensured that all staff received training and supervision on the new policies Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 10 and procedures and improved standards of record-keeping in the home. The home now has a good framework for identifying and taking action to meet service users needs. The result seen by the inspector was a significant improvement in the recording of identified needs in both short and long term care plans used by the home. For example, care plans are prescriptive, specifying the type and frequency of nursing interventions and treatments, such as the type of dressings used and the number of times service users should change position to avoid pressure sores. Assessment charts were comprehensively completed, such as the Waterlow Charts; Nutritional Risk Assessments; Moving and Handling Assessments; Wound Pressure Assessments and the recording of monitoring procedures for pressure sores, all of which were case tracked to needs identified in care plans. All care plans and assessments were signed by service users and or their relatives, as required. One area in care plans still requiring improvement however is in the problems/risks associated as a result of needs identified. This section had been completed with reference to the reason for the development of the need (ie pressure sore / due to immobility) rather than how the area of need presents as a risk to service users. It is recommended that the risks presented to service users as a result of their identified needs are clearly specified in care plans. This will enable staff members to have an improved understanding of the issues concerning the health and safety and preventative actions needed by service users. Medication administration and recording was examined and deemed to have no errors at the time of inspection. Service users spoken to informed that the staff treat them well and they are happy with the service they receive. The inspector received 17 comments cards as part of the consultation process prior to the inspection, including 15 gathered by the home by service users and relatives. Most of these comments gave positive feedback about the care and services of home. The negatives concerned the lack of information about forthcoming inspection (the inspector viewed a letter clearly displayed in the foyer about the inspection) and the lack of knowledge that inspection reports are available to service users. The Registered Manager agreed to address this. Communication procedures with other professionals and relatives have improved with the introduction of new forms to evidence communication and action taken by health professionals, the G.P and significant communication with relatives, meeting another requirement made at the last inspection. The inspector was impressed with the use of these forms already in practise. The inspector observed statements by service users confirming their practical wishes in the event of serious illness and death. Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Service users have opportunities to engage in a variety of social, cultural and religious activities. Service users are offered choices, encouraged to exercise control and maintain their independence to their ability wherever possible. Service users are generally satisfied with and consulted about their meals. EVIDENCE: Service users spoken to informed the inspector that they were satisfied with the social activities within the home. Comments cards received also reflected this. There is a full-time Activities Co-ordinator, formerly a care worker in the home, who undertakes 2 hours of activities each day on each floor. Activities are displayed on the wall on the ground floor. They include singing, dancing, crafts, bingo and trips out in the minibus, such as to the park and seaside and also for meals out. Service users’ cultural and spiritual needs are taken into account as part of their assessed needs. One service user regular eats currys. The inspector viewed a record in one file of a service user who watches Chinese films and goes to a Chinese day centre. A priest regularly visits. The Registered Manager informed that some service users are assisted to go out for personal shopping in the minibus at their request. Service users are able to do their own laundry should they prefer to do so. The menu examined offered varied and nutritious meals. One service users’ relative complained about the choice of food (too much mash potato and occasionally poor food). Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 12 Service users are consulted about their meals the day beforehand and according to the Registered Manager are also able to choose meals not on the menu with a variety of alternative foods available. Service users spoken to informed they liked the meals. Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 The home has evidenced that it listens and acts upon the views of service users and their relatives. Service users benefit from staff who are aware of adult protection issues. Service users’ legal rights are protected. EVIDENCE: There were no recorded complaints since the last inspection. Interviews with service users and the pre-inspection comments from service users, their relatives and staff reflected a sense of satisfaction with the services, facilities and activities within the home, particularly with the staff. The home openly displays its policy on complaints. A requirement made at the last inspection for the home to develop its own Adult Protection Policy was met. Staff interviewed confirmed they had received training on adult protection. Service users are enabled to vote and are given their own mail. Advocacy services are available. Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25, 26 Service users live in comfortable, generally well-maintained surroundings. There are sufficient facilities in the home and the home meets its stated aims and objectives. Some requirements are given. EVIDENCE: The house is generally clean, well maintained and well decorated, though decoration to walls in some rooms is required. Bedrooms contained personal effects such as pictures and photographs and other personal items. There are sufficient bathroom facilities in the home and aids and adaptations are in place, including assisted baths and hoists. There are comfortable lounges for socialising and activities on each floor. One service users’ room had a strong urine odour coming from her bed. Despite the daily cleaning, the Registered Manager is required to ensure that every attempt is made to eliminate strong odours. Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Service users benefit from skilled, competent and knowledgeable staff who receive regular training and supervision to support them to undertake their duties and responsibilities. A statement of fitness must be available for all employees of the home. EVIDENCE: There are sufficient staff numbers to meet service users’ needs, including 9 nurses and 5 senior care workers who also have management and supervisory responsibilities. Service users informed that staff were responsive if they required assistance. Staff interviewed advised that there was good communication and team working among the staff on each floor. Staff morale was reported to be good. Supervision and appraisal notes were seen in staff files and confirmed as being received by staff interviewed. All staff are given induction following their appointment. Training certificates were seen in files. Staff reported that they received regular training and updates in their training. The Registered Manager has offered additional training regarding improved standards of record keeping and operational procedures in the home to ensure that all staff are competent to fulfil their duties following the last inspection. Staff files were examined. Most documents with the exception of one were available in the files. A requirement is given for a statement of mental and physical fitness to be available for all employees in the home. Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38 Service users benefit from living in a home which is managed by a person with experience in their field and who has demonstrated competence to lead this service. There is a positive ethos and management approach to the home. Service users’ health and safety is promoted and protected in the home. EVIDENCE: The Registered Manager has previous experience in management as a nurse and as a sister in a hospital prior to her employment in the home. She also has an NVQ Level 4 and further relevant professional qualifications. She has demonstrated her capacity to take on board issues raised at the previous inspection and has taken action to improve practises within the home. She is now monitoring staff performance to ensure that standards are maintained. Staff and service users inform that the Registered Manager is approachable and responsive when approached. Records, policies and procedures examined comply with practises carried out and case tracked within the home. Requirements given at the last inspection concerning the need for an electrical wiring test and for water temperatures to be adjusted close to 43 degrees were Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 17 achieved. The risk assessment produced as regards the decision not to have window restrictors on the ground floor needs to improve, therefore this requirement is restated. Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 1 3 1 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 2 Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? No 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 YA24 Regulation 23 2(b) Requirement The Registered Manager must ensure the decoration of all walls requiring repair. The Registered Manager is required to ensure that every attempt is made to keep the premises free from offensive odours. The Registered Manager must ensure that a statement of mental and physical fitness is available for all employees of the home. An improved risk assessment as regards the decision not to have window restrictors on the ground floor is required. Timescale for action 20/01/06 2 YA26 16 2(k) 20/01/06 3 YA29 17 (2) 20/01/06 4 YA38 13 (4) 20/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 20 No. 1 Refer to Standard YA7 Good Practice Recommendations It is recommended that the risks presented to service users as a result of their identified needs are more clearly written in the relevant section of the care plans. Manor Farm Nursing Home DS0000007361.V249865.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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