Inspection on 12/01/06 for Manor House

This inspection was carried out on 12th January 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 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 House 14/01/10

Manor House 18/02/09

Manor House 27/11/07

Manor House 21/11/06

Manor House 11/08/05

Manor House 21/02/05

Manor House 13/07/04

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

CARE HOMES FOR OLDER PEOPLE Manor House Higher Tremar Liskeard Cornwall PL14 5HJ Lead Inspector Philippa Cutting Unannounced Inspection 12th January 2006 09:30 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 House DS0000048225.V272835.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 House DS0000048225.V272835.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Manor House Address Higher Tremar Liskeard Cornwall PL14 5HJ 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) 01579 343534 Mrs Nichola Jayne Broadhurst Mr Robert Anthony Broadhurst Care Home 16 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (16) Manor House DS0000048225.V272835.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 6 adults aged over 65 years with Dementia (DE(E)) Service users to include up to 16 adults aged over 65 years with a mental illness (MD(E)) Total number of service users not to exceed a maximum of 16 Date of last inspection 11th August 2005 Brief Description of the Service: The Manor House is a privately owned older style house and, although only approximately five miles from the town of Liskeard, it is situated in a quiet moorland village. The home offers care and accommodation to up to 16 older people who have mental heath needs or dementia. Accommodation is in mainly single rooms, one of which is en suite. Rooms are available on the first and ground floors with a stair lift linking the two floors. Communal rooms and a small sun lounge are available on the ground floor with an additional large sitting room (that includes facilities to dine) on the first floor. The home has a garden at the rear, which service users can use in clement weather. The owners live in a property adjacent to the home. Manor House DS0000048225.V272835.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on a weekday between 10.0am & 3.15pm. One of the proprietors advised that a number of service users & staff had been unwell in the last few days therefore this inspection concentrated on records and paperwork with a brief inspection of the premises rather than spending a lot of time with service users. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Manor House DS0000048225.V272835.R01.S.doc Version 5.0 Page 6 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Manor House DS0000048225.V272835.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 House DS0000048225.V272835.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): 1,2,5 People are invited to visit the home and gain the necessary information before making decisions about seeking a placement. Contracts for service users are in place. EVIDENCE: The family of a prospective service user visited the home during the inspection and had the opportunity to see the accommodation and talk to staff & one of the registered providers. Contracts from Social Services, where they are the purchaser of the service, were noted in service users’ files. The registered person said that she visits prospective residents to assess their needs to ensure that the home can provide these and that they are compatible with existing service users. A place is not offered if she feels this cannot be met. Manor House DS0000048225.V272835.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 Each service user has an individual care plan outlining their needs. The majority are full and satisfactory but some need further information to be completed in total. Service users’ health needs are well catered for. The administration of medication is a dedicated task for the member of staff responsible so that he or she is not interrupted whilst carrying this out. EVIDENCE: The care plans for all the service users were read. Those for people who have been in the home longest are full, with each section completed. More recent admissions have not had all the sections filled in yet. The parts that are not completed related to people’s emotional & social wellbeing and in some cases family details. Essential information about medication and mobility etc were included but the incomplete sections are the ones that will probably add quality to the care offered, as they will indicate a person’s preferences and motivation. In some instances more detail would be useful. For example an entry stated that ‘X needed skilled handling’. There was no further information as to why, when or how this was needed. If there is a known trigger factor that might Manor House DS0000048225.V272835.R01.S.doc Version 5.0 Page 10 provoke a problem this information would be helpful for staff, although the registered person said she felt the staff were aware of them. There were other instances where an entry prompted more questions. Where a person is identified as having a high risk of falling, the action taken to reduce this should be noted or, if it is no longer pertinent, the care plan should be amended. Not all care plans are signed. Relatives, if not the service user, should be encouraged to do so, to show their accord with, and understanding of, the care provided. These comments not with standing, the care plans were in a helpful format and had been reviewed at monthly intervals with changes being noted as needed. The records showed that advice is sought from professional staff where a need is indicated and the community nurses deal with dressings and treatments within their remit. Staff have had training in the safe handling of medication and would not undertake its administration until they have been instructed. The majority of service users receive tablets via a monitored dose system. Three are still registered with a practice that dispenses prescriptions from the surgery. Consequently the registered provider has more confidence if she and a witness, put a week’s medication into a dosette box rather than dispense directly from the bottles. This has been discussed before and she is aware that the practice is not the preferred one, as it constitutes secondary dispensing. However it is acknowledged that no mistakes have been made. The medication administration record sheets have been colour coded by the registered provider to match the colours of the blister packs as an additional safety measure. Manor House DS0000048225.V272835.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): EVIDENCE: Due to sickness, time was not spent with the service users on this occasion. Manor House DS0000048225.V272835.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Staff are made aware of the issues and importance of the protection of vulnerable adults (PoVA) in order to safeguard service users. EVIDENCE: The complaints procedure is displayed in the home. It is unlikely that all the service users would be able to instigate this on their own behalf. It is likely that any problems or distress would be exhibited through behaviour. Staff have had an update on PoVA the since the last inspection. Manor House DS0000048225.V272835.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,25 The accommodation was viewed briefly. It appeared to be in good order with on going maintenance to improve the overall standards and safety of service users. Service users’ rooms were arranged to suit a person’s needs and contained personal items and ornaments etc. of their choosing. EVIDENCE: A brief walk round the home showed that it was clean and tidy. Service users’ rooms were decorated in a satisfactory manner and personalised to their liking. Service users now have a choice of communal rooms with two (plus dining room) on the ground floor and one upstairs. Signage has been introduces to stop people using the kitchen as a thoroughfare to a bedroom at the far end of the home. Equipment to promote independence and to assist staff was noted in the form of walking & toilet aids, lifting and bath hoists. Manor House DS0000048225.V272835.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 29,30 This inspection looked at records rather than meeting staff. From the information available in staff files, these appeared to contain the required information. EVIDENCE: Eleven staff records were inspected, three for staff who were working in the home previously and eight for staff employed by the present registered persons. Of the latter group four appeared to have only one written reference, telephone references having been taken for the second one. The registered person is urged to obtain written references to supplement information that may be given by telephone. Criminal Records Bureau & PoVA checks are requested for all staff. The induction for new staff is recorded in a printed format where the tasks are outlined. On completion both the instructor and the learner sign it. New standards for induction were introduced in September 2005, which will become a requirement in September 2006. The registered person is advised to check that her current format will meet these targets. All staff had had an appraisal. Manor House DS0000048225.V272835.R01.S.doc Version 5.0 Page 15 The people with whom the inspector spoke briefly were pleasant, helpful, and all appeared to enjoy their work with this particular client group. Details of training that they had undertaken were included in their files. Manor House DS0000048225.V272835.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): 37,38 Due to illness these standards were not inspected apart from the accident and fire records. These were maintained satisfactorily. EVIDENCE: There were six entries in the accident book since the last inspection and all appeared to have occurred at night or in the early hours. They are properly recorded and indicated that no one person has had more than one accident. Looking at the people involved in any accident can reveal if there are any ‘patterns’ emerging that could be changed or altered in some way to prevent falls etc. The inspector identified six possible events where the Commission for Social Care Inspection had not been notified of either a death or an incident. The regulations require that these should be reported ‘without delay’. Manor House DS0000048225.V272835.R01.S.doc Version 5.0 Page 17 This was discussed with the registered person later. She said notification of two recent deaths have since been forwarded to the Commission. Reports for the home have been made on two incidents but have not yet been filed. The registered person said that two had been reported in the daily notes, but she felt had over dramatised a minor discussion; the third had been dealt with by involving the right people. Never the less the home is reminded to copy the Commission in on such occurrences. Manor House DS0000048225.V272835.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 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 3 X STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X 3 2 Manor House DS0000048225.V272835.R01.S.doc Version 5.0 Page 19 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 OP12 Regulation 37 Requirement The registered person shall give notice to the Commission without delay of the occurrence of - (a) the death of any service user, including the circumstances of his death;(b) the outbreak in the care home of any infectious disease which in the opinion of any registered medical practitioner attending persons in the care home is sufficiently serious to be so notified;(c) any serious injury to a service user;(d) serious illness of a service user at a care home at which nursing is not provided;(e) any event in the care home which adversely affects the wellbeing or safety of any service user;(f) any theft, burglary or accident in the care home;(g) any allegation of misconduct by the registered person or any person who works at the care home. (2) Any notification made in accordance with this regulation that is given orally shall be confirmed in writing. Timescale for action 31/01/06 Manor House DS0000048225.V272835.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations All sections of a service user’s care plan should be completed and a signature from the service user or a relative obtained to show understanding and agreement with it. Manor House DS0000048225.V272835.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 House DS0000048225.V272835.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!