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Inspection on 26/07/06 for Manor Farm House Residential Home

Also see our care home review for Manor Farm House Residential Home for more information

This inspection was carried out on 26th July 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home employs caring and attentive staff who are much appreciated by the residents. "The staff are always kind and helpful" said one, and "you only have to ask and its done" said another. "The staff are very good when I need something." "The care and attention I receive by all the staff is excellent." The home asks new residents for their views on how the home managed their admission. This is good practice and part of the quality assurance policy to continually improve the home. The home has put staff through a comprehensive dementia care training programme which enables staff to provide the most appropriate care for those with that condition. Residents and the home are well supported by the doctors and nurses of the local practice and by the hospital consultant responsible for dementia patients The home provides a varied traditional menu of well-cooked food, which on the day of the visit was pleasing and looked appetising. There is an excellent Fire Risk Assessment which meets the new Fire Precautions Regulations. The home encourages visitors to use an anti-bacterial gel to clean their hands when entering and leaving the home. This is to reduce any spread of infection.

What has improved since the last inspection?

Procedures for the recording of the use of over the counter medicines have been tightened to make sure all instances are recorded. Parts of the home have been redecorated which has improved the general appearance of those areas. Training of staff in the policy and procedures of adult protection has been undertaken as part of staff meetings. The staff are now better trained to care for people with dementia, after all care staff undertook an accredited training course.

What the care home could do better:

The home needs a substantial programme of redecoration and re-furbishment. This has started but is only progressing slowly, as the decorator is only employed for two days a week. This programme needs to be continued and, if possible accelerated, to improve hygiene, reduce the risk of cross-infection, and to brighten up the home for the residents. No towels or incontinence aids must be kept on open shelves in a bathroom. Incontinence aids should be more discreetly stored than on top of a wardrobe in the resident`s bedroom. No new employees must be taken on until all references have been received in writing, and until a record of the CRB certificate or POVA list search result has been received. All care staff must receive one-to-one supervision sessions at least six times a year. These sessions must be recorded in the person`s file. In hot weather, residents should have access to fluids at all times. It would greatly benefit the residents if a second assisted bath was installed.

CARE HOMES FOR OLDER PEOPLE Manor Farm House Residential Home Church Road Kessingland Lowestoft Suffolk NR33 7SJ Lead Inspector John Goodship Key Unannounced Inspection 26th July 2006 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 House Residential Home DS0000024440.V306227.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 House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor Farm House Residential Home Address Church Road Kessingland Lowestoft Suffolk NR33 7SJ 01502 740161 01502 740756 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) Mr Hector Jackson Mrs Alison Palmer Care Home 25 Category(ies) of OP – 25 registration, with number DE(E) - 10 of places Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th January 2006 Brief Description of the Service: Manor Farm House is a residential care home registered under the provisions of the Care Standards Act 2000 to accommodate 25 older persons. It is privately owned by Mr and Mrs Jackson. Located in the village of Kessingland, Manor Farm House is close to main amenities although transport would be required to access them. Manor Farm House was first registered in 1983 and consists of a two storey main building with a bungalow extension that is linked to the main building. The Home provides 17 single bedrooms and four double bedrooms that are all provided with a wash hand basin. There is a choice of areas for service users to sit, either in the large lounge in the extension, a smaller seating area, or the conservatory. The dining room is situated at the front of the home and provides views of the open countryside. There is a stair-lift fitted to assist service users to access the first floor. At the time of this inspection the fees ranged from £331.00 to £395.00 per week. Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the first under the Commission for Social Care Inspection’s new policy entitled “Inspecting for Better Lives”. This inspection was aimed at assessing at least all the key national minimum standards, indicated under each Outcome Group. The Manager was present the whole time. The visit lasted 6.5 hours. Twenty four people were in residence, as one person had died in the home the day before the inspection. The inspector toured the home, spoke to several residents in their own rooms, in the lounge and in the dining room, spoke to two members of staff and a relative, as well as a visiting doctor. Comment questionnaires had been received from 19 residents and from 15 relatives. Their comments have been included on this page as well as in the main body of the report. What the service does well: The home employs caring and attentive staff who are much appreciated by the residents. “The staff are always kind and helpful” said one, and “you only have to ask and its done” said another. “The staff are very good when I need something.” “The care and attention I receive by all the staff is excellent.” The home asks new residents for their views on how the home managed their admission. This is good practice and part of the quality assurance policy to continually improve the home. The home has put staff through a comprehensive dementia care training programme which enables staff to provide the most appropriate care for those with that condition. Residents and the home are well supported by the doctors and nurses of the local practice and by the hospital consultant responsible for dementia patients The home provides a varied traditional menu of well-cooked food, which on the day of the visit was pleasing and looked appetising. There is an excellent Fire Risk Assessment which meets the new Fire Precautions Regulations. The home encourages visitors to use an anti-bacterial gel to clean their hands when entering and leaving the home. This is to reduce any spread of infection. Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home needs a substantial programme of redecoration and re-furbishment. This has started but is only progressing slowly, as the decorator is only employed for two days a week. This programme needs to be continued and, if possible accelerated, to improve hygiene, reduce the risk of cross-infection, and to brighten up the home for the residents. No towels or incontinence aids must be kept on open shelves in a bathroom. Incontinence aids should be more discreetly stored than on top of a wardrobe in the resident’s bedroom. No new employees must be taken on until all references have been received in writing, and until a record of the CRB certificate or POVA list search result has been received. All care staff must receive one-to-one supervision sessions at least six times a year. These sessions must be recorded in the person’s file. In hot weather, residents should have access to fluids at all times. It would greatly benefit the residents if a second assisted bath was installed. Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 8 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 House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 9 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): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can be assured that they will have sufficient information to decide if this home is where they wish to live. The home will also collect information to assure the person that the home can meet their needs. EVIDENCE: The Statement of Purpose and Residents Handbook had been recently revised to include mention of the ten places which were registered in May 2006 for older people with dementia. All residents confirmed on their comment cards that they had received a contract for living in the home. The one vacancy in the home was in a shared room. The manager stressed that the pre-admission assessment would have to bear this in mind. A trial period for all parties was the home’s policy and would be followed for any referral to this vacancy. The manager said there was a good relationship with Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 10 the local referring office of Suffolk Social Care Services, which usually resulted in only appropriate referrals being made. Prospective residents were offered opportunities to visit the home. One resident said: “I came and viewed the home, and spoke to the manager about my needs.” New residents were asked to complete a post-admission questionnaire which covered all aspects of admission including understanding the paperwork and the manner in which they were welcomed into the home. One completed questionnaire was seen in the file of the newest resident. All items were assessed as satisfactory. Standard 6 is not relevant to this home. Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Needs are assessed and reviewed regularly to ensure that residents are properly cared for. Medication procedures have been improved for the protection of residents. EVIDENCE: The manager described the care given to a recently deceased resident who had died in the home. The GP gave daily support, and the district nurse had set up a syringe driver for pain relief. The manager tried to follow the expressed wishes of the deceased person regarding what happened to them after death. The need for a coroner’s referral changed the circumstances but the manager was able to ensure that the wishes were eventually respected. The GP would be following up with the Primary Care Trust some queries which the manager had raised about protocols. The home now had registration to care for up to ten residents with diagnosed dementia. There were currently three residents who had been diagnosed with dementia either before their admission or during their stay in the home. Three more were awaiting assessment. Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 12 The manager reported that the home had good links with the local psychogeriatrician who responded quickly to calls from the home. She said that the local GP practice was also quick to visit if asked. This was confirmed by two residents on their comment cards. During the early part of the morning, it was noted that the residents who were sitting in the lounge did not have any drinks which they could access. It was a very hot day. However later in the morning, drinks had been distributed. The inspector observed the lunch time drug round. Most recipients were in the dining room but a few were in their rooms. The correct procedure was followed for those in their rooms. The trolley was used in the dining room and was used securely. Medicines were observed to be taken before the senior carer signed the sheet. The MAR sheets were examined and there were no gaps in signatures. The stock levels tallied with the quantity of drugs delivered from the supplier and administered. All bottles were seen to have been dated on opening and were within the allowed timescale. The pharmacy supplier visits quarterly to do an audit of the medication procedures. The home had complied with a previous requirement to record GP approval for the administration of over-the-counter medication and homely remedies. A locum GP arrived at lunch time to see a resident who had been admitted from hospital a few days previously. The staff moved the resident out of the dining room to their own room for privacy while the doctor examined them. The doctor was checking that an ear infection was clearing up, before the home could arrange an appointment at the local hearing aid clinic. Although the locum GP had only visited the home on a few occasions, they felt that residents were well cared for and were safe. They had never been called out unnecessarily. The manager said that a GP was asked to visit each new resident to review their medical needs and to review their medication. Care plans for three residents were examined. They all listed relevant aspects of care needs with recorded monthly reviews. In addition there were risk assessments specific to each person. One had an assessment to cover their smoking, another to cover their trips to the pub. Records were kept of all visits by health professionals including the chiropodist. In addition, the home issued a post-admission audit questionnaire to check if people received sufficient information about the home and were happy with the way they were settled in. The one seen in a care plan expressed the satisfaction of the resident with the process of admission. The care plan proforma included a section on “Expressed wishes on death.” Not all were completed as, according to the manager, some residents or their relatives found it difficult to address this sensitive area. Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 13 The care plan for the most recent admission, three weeks previously, contained detailed daily notes about the behaviour of this person, as they had a diagnosis of dementia. The information would be used at the first review to provide a proper care plan with instructions for the staff on providing the most appropriate care. One double room had incontinence pads stacked on top of a wardrobe. The manager agreed that this was unsatisfactory, and that this practice occurred in other rooms as all but six residents required these aids. The district nurse had told the home that the pads were the personal property of the resident once their needs had been assessed by the Continence nurse. To re-order, the nurse needed to check easily how many had been used. However the manager was asked to protect the privacy and dignity of residents by finding alternative and more discreet storage for the bulk of the pads. Manor Farm House Residential Home DS0000024440.V306227.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can choose how they interact with other residents, and can maintain contact with their friends and relatives. They can be assured that their nutritional needs will be met. EVIDENCE: Breakfasts were mostly taken in the dining room, although some residents told the inspector that they chose to have theirs in their room. On the day of inspection, most residents ate their lunch in the dining room. There was a menu board on the wall which gave the choice for main and dessert courses. Three staff were helping to serve the meal, and to support those that needed food cutting up, or encouragement to eat by putting food on the spoon for residents to feed themselves. It was noted that residents were allowed sufficient time for their meal. The menu for the week was varied and it was seen that there were sufficient fresh vegetables and fruit available in the dry store. One resident said: “There is always plenty of choices and the food is excellent and plenty of it.” One meal had been liquefied for the comfort of a resident with gingivitis. Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 15 The daughter of a resident was happy to talk to the inspector and expressed their satisfaction with the care given to their mother. There were other visitors in the home during the day. One visitor came regularly to talk to a resident and take them out. Many residents had lived locally so had contacts with the community in the village. One relative said: “ They always tell me about any change in my relative’s health.” Preferences for activities of daily living were listed in their care plans. Several residents explained to the inspector that they “preferred” to be in their rooms and that staff respected this and served them their meals in their rooms “as they wished”. There was a published activities diary in the lounge, consisting mainly of music, card games and bingo. The manager explained that other activities had been introduced but interest waned. For example, gentle exercise sessions had been led by an outside person, but this had since stopped for lack of participants. Staff said it was increasingly difficult to generate interest. They did say that what the residents liked was when the staff dressed up and performed for them. From the Comment cards completed by residents, seventeen said there were always or usually activities arranged by the home that they could take part in, and two people said there were sometimes activities they could take part in. One resident said: “I like to join in the singing but nothing else.” Another said: “ I don’t like any activities but they are avoidable.” Staff commented that reminiscence quizzes had proved popular. These had been rented from a local source. These had provided a particularly interesting activity for those with early onset dementia. Manor Farm House Residential Home DS0000024440.V306227.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s prompt action if things go wrong, and from staff trained to recognise and report any abusive actions. EVIDENCE: The home had a complaints procedure that was given to residents, or their relatives when admitted, and was displayed on a notice board in the home. The procedure met requirements. The home’s complaints book was available to visitors to the home. Recent matters recorded included, for example, that a bedroom radiator was not working, that some laundry was missing, and that a resident did not understand that their fluid intake was restricted due to their medical treatment. A visiting relative had informed the inspector on a previous visit that the manager and owner were “very approachable and seemed to do their utmost in sorting out any problems”. Two residents said that if they had a concern, they would speak to the manager, although they had never needed to. The registered manager had had training on protecting adults at risk of abuse and had a copy of the Suffolk inter-agency policy, procedures and guidelines. Staff files looked at during the inspection did not provide evidence of staff training in relation to protection but staff confirmed that the February staff meeting had included a training session on adult protection. The training notes from the session were available. Two of the staff spoken to during the Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 17 inspection said that if they had any concerns regarding the safety of residents they would report them to the manager. Manor Farm House Residential Home DS0000024440.V306227.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,26 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 can expect that the home offers a safe environment but that there are areas within the home which are in urgent need of redecoration. Residents and relatives can expect that resident’s rooms will be safe, comfortable and that they will have the opportunity to have their own possessions around them. Residents and their relatives can expect the home to be generally clean and pleasant, but the bathroom next to the conservatory puts residents at risk of cross-infection by a low level of hygiene and decoration. EVIDENCE: Toilets were accessible and clearly marked. The ratio of assisted baths / showers to residents would not meet current standards. However the home was able to be registered with the provision it had in 2002. The previously inadequate shower room had been replaced with a spacious and suitable Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 19 alternative. One bathroom which currently contained an ordinary bath was being considered for the installation of an assisted bath. The sluice was provided in a separate room away from residents, WCs and bathing facilities. The bathroom off the conservatory was in a poor state of decoration. The radiator needed painting. There was scaling in the bath. Towels and incontinence pads were being stored in this room on open shelves. This was a cross-infection hazard. The doors to rooms 8 and 9 were very low. While that may not be a problem for most of the staff or the residents in those rooms, visiting health staff and other people may easily hit their heads on the lintel. There were big cracks in the corner of Room 15. The home had a part-time decorator for two days a week, who was working their way through the home. Areas were seen to have been redecorated. Overall residents’ rooms were seen to be clean, well decorated and full of their personal possessions. The absence of a shaft lift meant that only residents who were safe to use the stair lift could take a room on the first floor. The manager had a list of replacement furniture that was needed, but the manager stated that the financial budgets for this year meant that it was unlikely any action could be taken this year. Priority would be given to meeting staff training needs. Although there was a small sitting room on the first floor, no one was using it, and the manager said it was only used occasionally by visitors when talking to residents. There was a hand-cleansing gel dispenser opposite the front door which visitors were asked to use to protect the home from cross-infection. A tour of the home showed it to be clean with no unpleasant odours. One resident said: “The home is very clean and I always have a lovely clean bed.” Manor Farm House Residential Home DS0000024440.V306227.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives can be assured that residents’ needs will be met by the numbers and skill mix of staff and that the home will provide training to ensure that the staff are competent to do their jobs. However the home must follow its recruitment procedure fully in all cases to evidence that residents are properly protected. EVIDENCE: There was a staff rota displaying which staff were on duty throughout the day and night. There was always a senior carer on duty in waking hours and numbers of staff were increased at peak times. The rota specified which tasks each person had responsibility for that shift, and this rotated round each person. The home had no vacancies at the time of inspection. It did not use agency staff as it was able to rely on the permanent staff to cover any gaps through holidays and sickness. At the time of the visit there were 4 care staff and the senior carer on duty. The inspector noted that staff were able to go about their work and respond to residents needs in a calm and unhurried manner. Residents were seen to be receiving individual attention as was required. Staff behaved in a courteous Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 21 manner. At lunch, residents who required support were mainly seated at one table so that staff assisting them were always at hand. One resident said: “The carers always have time to listen and put a smile on my face.” Eight staff had completed NVQ Level 2. Nineteen staff had completed a distance learning course in Dementia Care, and three more staff were studying on it. New staff were expected to do an NVQ course, as well as the dementia care course. Staff who were spoken to confirmed that they had undertaken training, either as part of their NVQ, in-house refreshers or external courses, in moving and handling, food hygiene, infection control, health and safety, adult protection, dementia care and safe administration of medication. The latter was undertaken by senior carers, who were the only care staff responsible for the administration of medication. The manager and senior carer were accredited trainers in moving and handling, and the manager was also a trainer in adult protection. The files for two staff were examined. Both had started within the previous four weeks. Although one contained all the identification and reference checks required, the other, for a cook, was missing two essential documents. Firstly a second written reference had not been received. The manager said she had received a verbal reference on the phone but this had not been recorded. Secondly the POVA list search result for this person had apparently been viewed on the computer according to the manager, but no record was available in the file. A senior carer confirmed that staff meetings were held every six months, the last in February 2006. That meeting had included a refresher session from the manager on adult protection. Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 22 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): 31,32,33,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives can expect that the home is well run and that the manager is able to discharge her responsibilities in the best interests of residents. Residents and relatives cannot be fully confident that the staff and the manager can meet their needs, until there is a programme of staff supervision. Residents cannot be assured that their health is protected until the matters relating to hygiene and cross-infection have been actioned. EVIDENCE: Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 23 The manager had worked at the home for many years and continued to strengthen her experience and knowledge by developing her knowledge of providing services to people who experience dementia. She had completed the Registered Managers Award. She was an accredited trainer in Moving and Handling, and had done a four month dementia care course. Two residents’ rooms were fitted with a closure device which allowed the resident to keep their door open, but closed it automatically when the fire alarm sounded. More could be used but the manager said that the home could not afford to buy more at present. No doors were seen to be wedged open. Although full staff meetings were held only every six months, the manager stated that small staff meetings took place every week in the staff room. These were not documented. Quality checks included the quarterly drug audit by the pharmacist, room checks by the manager for cleanliness, and sample audits of care plans to ensure they were fully completed and up-to-date. There were also annual appraisals for staff. However there was no planned regular supervision programme for staff to meet the standard of at least six sessions a year. The manager stated that group supervision took place but not one-to-one sessions. The Commission had been notified of all incidents listed under regulation 37 of the Care Standards Regulations (2001). The home had an up-to-date and comprehensive Fire Risk Assessment now required by legislation. The entrances to the home were protected by keypad entry systems, except the one to the internal secure garden. One resident was in the garden during the inspection. There was a health and safety issue in the bathroom off the conservatory, which was in a poor state of decoration, with paint peeling off the radiator. There was scaling in the bath. Towels and incontinence pads were being stored in this room on open shelves. This was a cross-infection hazard. Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 24 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 3 8 3 9 3 10 3 11 4 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 X 18 3 2 3 3 X X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 X 2 Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 25 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 OP26 Regulation 13(3) Requirement Timescale for action 31/08/06 2 OP19 13(4), 23(2) 3 OP29 19(1)(b) 4 OP36 18(2) The registered person must make suitable arrangements to prevent the spread of crossinfection by ensuring that no items such as towels and incontinence aids are stored on open shelves in bathrooms. The registered person must 30/09/06 ensure that the home is kept in a good state of repair by taking urgent action to clean and redecorate the bathroom off the conservatory. The registered person must 26/07/06 obtain all the documentary evidence listed under this regulation before employing a new member of staff. The registered person must 31/08/06 ensure that persons working at the home are appropriately supervised. Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 26 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 2 3 4 Refer to Standard OP8 OP10 OP21 OP36 Good Practice Recommendations The registered person should ensure that residents have access to fluids at all times. The registered person should find a more discreet place to store incontinence supplies while enabling them to be identified to a named resident. The registered person should plan the addition of a second assisted bath as soon as possible. The registered person should implement without delay a programme of one-to-one supervision sessions, taking place at least six times per year. Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Manor Farm House Residential Home DS0000024440.V306227.R01.S.doc Version 5.2 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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