CARE HOMES FOR OLDER PEOPLE
Manor House Station Road Annfield Plain Co Durham DH9 7UZ Lead Inspector
Kathy Bell Unannounced 13th June 2005 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 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 v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Manor House Address Station Road Annfield Plain Co Durham DH9 7UZ 01207 232 313 01207 232 313 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Durham County Council Mrs Jacqueline Thompson Care Home 28 Category(ies) of Dementia - over 65 years of age (9), Learning registration, with number disability over 65 years of age (6), Old age, not of places falling within any other category (28), Physical disability (8) Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 Physical Disability 30/12/2003 Date of last inspection 6th January 2005 Brief Description of the Service: Manor House is registered to provide care (but not nursing care) for up to 28 people. The home is divided into three units on two floors. One unit provides a service for people who need care for a short period, with the aim that with intensive support and physiotherapy they can return to their own homes. The other units provide care for some older people with learning disabilities, up to nine people with dementia and other older people .The home was purpose-built and is part of a complex which includes sheltered flats and a day centre. The home can provide limited support and meals to people in the flats. The home is in the centre of the village of Annfield Plain, with a supermarket, shops, pubs, club and surgeries within easy reach. There are good bus services to the town centres of Consett and Stanley. Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was one of the two routine inspections which are carried out each year. It took place during one day in June 2005. The inspector looked at the building, care plans (which describe the care each person needs) and other records and spoke to seven residents, two relatives and three members of staff as well as the manager. What the service does well: What has improved since the last inspection?
The bathroom in the attached Day Centre has been renovated so that it is suitable for use by people who need to use a hoist and it is available for the home to use. Each unit in the home has one bathroom: this extra one makes sure that a bathroom will always be available when needed. Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 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 standard(s) 3 &6 People moving into the intermediate care unit had had their needs assessed by care managers or hospital staff. Although most people had been carefully chosen as they could benefit from the special care provided, sometimes people were sent there although it could not meet their needs and the needs of existing residents at the same time. The management of the home recognises this is a problem and they are taking action to make sure that any staff carrying out an assessment have access to all the information they need. In the intermediate care unit, people are supported and encouraged to become mobile and more independent again so that they can return home. EVIDENCE: Sometimes people had been referred from hospital to the intermediate care unit although they were suffering from dementia and would need staff to help them with most of their personal care. This would limit the time staff had available to help other people carry out their physiotherapy etc. A physiotherapist visits the unit two times a week , shows the staff on duty the exercises recommended for each person and provides written instructions for them. Residents described how the staff encouraged them to do their
Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 9 exercises and achieved the right balance between “pushing” them enough and being sympathetic. A list of people who had used this service showed that the majority of them had returned to their own homes. Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7&8 Each person living in the home has a care plan which describes the care they need and how the home will provide it. Most of them contained enough detail to make sure staff would be aware of what they needed to do for each person. In one case, some important information was missing but staff did know the information anyway because the resident had lived in the home for many years. The care plans for people in the intermediate care unit do not include peoples needs and preferences for leisure activities which means that staff may not always be aware of what they could do to make someones stay more pleasant. Staff make sure that people receive the health care they need. EVIDENCE: Care plans included detailed guidance for staff on providing personal care for each person, including if they needed help to move around or to bathe etc. . Before admission to the intermediate care unit, hospital staff had made a record of each persons needs, including whether they were at risk of developing pressure sores or had particular dietary needs. This served as the homes own care plan , with staff just recording in the daily notes residents choices about things like when they liked to get up. This is satisfactory because these people only stay in the home for about six weeks.
Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 11 However care plans of people in the intermediate care unit do not include leisure and social needs. One resident likes music and would have liked a radio or music player in his room. Although the television was provided in each room and other facilities in the lounge, this was a small thing which could have made his stay more enjoyable. A section on bathing needs was missing from the care plan of one resident. If staff did not know this information, they could cause this resident considerable distress, without meaning to. However in this home, new or agency staff are able to work with staff who know residents well so there is little risk that this would happen. Residents said that staff responded quickly to any health needs. Records showed clearly when staff had arranged for health care to be provided. Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 12 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 standard(s) 13 & 15 Residents can keep up contact with their families and friends. Some can continue to use community facilities. Residents receive a varied diet, suitable for their needs, which almost all of them enjoy. Although most were offered the choice of main meals, this was not always happening. EVIDENCE: Relatives confirmed that they are able to visit when they want to and are made welcome. There are set visiting hours (three times a day) for the intermediate care unit. The aim of these was to make sure that residents have time to see the physiotherapist, work on their exercises etc. A relative did not feel that this was unreasonable and he and staff confirmed that the home would not be too strict if relatives arrived at other times. Some residents still attend day services which use community facilities. The planned menus showed a varied diet,with plenty of traditional meals. There is a planned alternative for each meal for residents who need soft food to make sure they receive an enjoyable, varied diet as well. Residents praised the quality of the meals, said they had plenty to eat and liked the homecooked food. For two of the units, menu sheets which staff filled in each day were seen. The showed the main meal each resident had chosen each day and whether they had special diets. This makes sure that residents are able to choose and that
Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 13 the cook has the information he or she needs. In one unit, although residents said they would be given an alternative if they did not like the planned meal, they said they were not told in advance so they could ask for something different. Many people are likely to accept what they are given at the point where the meal is actually put in front of them so it is important to give them choices earlier in the day. There are enough staff on duty at lunchtimes to help people who cannot eat by themselves. Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 14 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 standard(s) These standards were not assessed during this inspection. EVIDENCE: Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 15 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 standard(s) 26 The home appeared clean and well maintained on the day of inspection. There was a problem with odour control in one room, despite the efforts of staff. EVIDENCE: The home seemed clean throughout and a relative who visits very regularly confirmed it was always this way. There was a very slight smell of urine in one room, although staff reported that the carpet was cleaned very regularly. Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 There are enough staff on duty at all times to meet the needs of residents. There is an assistant manager on duty throughout the day and evening to provide supervision and advice if necessary. EVIDENCE: Two staff are on duty on each unit from 7 a.m. until 10 p.m. during these hours there is always an assistant manager on duty. In addition, because the home also provides support to the sheltered flats attached to the home, there are additional shifts each day covering a total of 9 1/2 hours. These cover the busy times of day and can be used in the home if they are not needed for the residents of the flats. The manager is full-time. There are two staff awake on duty at night but the manager confirmed that she can increase this to three if necessary. As well as providing support to the flats, the senior staff from the home also manage the day centre in the same building. Staffing levels have been set at a high level to make sure that staff can respond to all these extra demands while still meeting the needs of residents of the home. Good staffing levels are also essential to meet the complex needs of some residents and to carry out the tasks expected in the intermediate care unit. Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed on this inspection. EVIDENCE: Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 19 No Are there any outstanding requirements from the last inspection? 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. 2. 3. Standard 3 7 26 Regulation 14 15 23 Requirement Timescale for action 31.8.05 Residents must only be admitted to the intermediate care unit if their needs can be met there. Care plans must always include 31.7.05 details of how personal care needs will be met. Further efforts should be made 31.7.05 to control the odour in one room, including, if necessary, replacing floor covering (with the agreement of the resident as far as possible). 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 3 Good Practice Recommendations When possible, the manager or senior staff should be given the opportunity to assess possible residents for the intermediate care unit before a decision is made on admission. Staff should consider the leisure needs for people who are admitted to the intermediate care unit. All residents should be offered a choice of meals. 2. 3. 12 15 Manor House v232419 b54 s31192 manor house v232419 130605 stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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