Inspection on 18/02/09 for Manor House

This inspection was carried out on 18th February 2009.

CSCI found this care home to be providing an Good service.

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 House 14/01/10

Manor House 27/11/07

Manor House 21/11/06

Manor House 12/01/06

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Manor House Higher Tremar Liskeard Cornwall PL14 5HJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Gurnell     Date: 1 8 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Manor House Higher Tremar Liskeard Cornwall PL14 5HJ 01579343534 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Robert Anthony Broadhurst,Mrs Nichola Jayne Broadhurst care home 16 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 16 dementia mental disorder, excluding learning disability or dementia Additional conditions: 0 0 Service users to include up to 16 adults aged over 65 years with a mental illness (MD(E)) Service users to include up to 6 adults aged over 65 years with Dementia (DE(E)) Total number of service users not to exceed a maximum of 16 Date of last inspection Brief description of the care home 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. Two lounge rooms, dining room and a small sun room are available on the ground floor with an additional large sitting room, with a dining table, Care Homes for Older People Page 4 of 27 Brief description of the care home on the first floor. The home has a pleasant garden at the rear, which people can use in clement weather. The owners live in a property adjacent to the home. Weekly fees for the home range from 357 to 400 pounds per week, dependent upon peoples needs. Items not covered by the weekly fees include personal toiletries and clothing, newspapers and magazines, and chiropody at hairdressing. Information about the services provided at Manor House can be obtained directly from the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The previous inspection of Manor House was undertaken on 27th November 2007 when the home was judged as providing adequate outcomes to the people living there. This inspection was unannounced and undertaken on 18th February 2009. As part of this inspection Mrs Broadhurst completed an Annual Assurance Quality Assessment (AQAA), a document that allows the home to tell the Commission how peoples needs are met, what has improved over the past 12 months and what further improvements the home wishes to make. We also send surveys to the people living in the home and the staff team to allow them to comment, anonymously if wished, about the quality of the services provided at the home. Two were returned to people living in the home and one from the staff team: all three commented favourably about the home. Care Homes for Older People Page 6 of 27 As part of this visit a tour of the building was made and all 15 people living in the home, a visiting relative and the staff on duty were spoken with, as were Mr and Mrs Broadhurst, the owners. Records relating to the care provided for four people were looked at. Documents relating to staff recruitment and training and health and safety were also looked at. What the care home does well: What has improved since the last inspection? What they could do better: Mrs Broadhurst has been asked to review the care planning documents to ensure they provide a full and accurate description of each persons care needs and the action required by staff to meet those needs. She has also been asked to keep medication administration practice under review to ensure the risk of errors occurring is kept to a minimum. Care Homes for Older People Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving to Manor House are provided with information about the home, and are invited to visit, in order to make an informed decision about whether it is right for them. The care needs assessment means that peoples needs are identified and planned for before they move to the home. Evidence: One person newly admitted to the home was spoken with, and he said that he was made very welcome and had settled it. Two other people who had moved in some time ago said that they were really pleased with the home, describing living there as very good and we consider this to be our home. The care plans for four people were looked at in detail and there was evidence that assessments had been undertaken to identifying peoples care needs prior to their admission. People had been asked about their preferences and how they wished to be Care Homes for Older People Page 11 of 27 Evidence: supported. Documentation was also in place, prior to admission, of external health and social care assessments. The owner gives a great deal of consideration to admissions to ensure people will be satisfied with the homely environment that is being offered at Manor House. Following the assessment process, and where possible a visit to the home, the owner said she writes to people confirming that the home was able to meet their needs. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social care needs are well met. The homes medication system, although not ideal, has safeguards in place to reduce risk. Evidence: Manor House provides care and support to 16 people who are both physically and mentally frail due to a dementia or a mental health need. All of the people living at the home were spoken with, and although not all were able to directly comment about the care and support they receive, those that were said that they were very happy living at home. They said the staff were kind and very helpful. Staff were seen to support people with respect and obviously had a close relationship with them. Those people who were not able to comment about the quality of the care they receive were seen to be well groomed and staff were able to describe their care needs well. Four care plans were looked at in detail and these contained a number of documents that described each persons care needs and any associated risks. The care plan format is one of a pre-printed page giving a number of headings with an area to write Care Homes for Older People Page 13 of 27 Evidence: a short comment regarding specific care needs. These forms give consideration to all activities of daily living such as personal hygiene, mobility, communication, eating and drinking and nutritional needs, and family relationships. Assessments had been undertaken with regard to the moving and handling, the risk of falling, skincare and the risk of developing pressure sores and anything identified particular to each person. Due to the small area provided to write comments, the information was brief and did not provide a full explanation of peoples needs nor the knowledge the staff held about each person. For example, one care plan said the person needed the assistance of one care staff with their personal hygiene but gave no explanation of what the person could do for themselves or in what way the member of staff should help. Each of the four care plans had been reviewed monthly and changes had been made to the care plans as peoples needs changed. The owner was advised to ensure that the care plans gave a more detailed description of peoples needs and the action required to meet those needs, to ensure consistency in care giving, and reflect the good practice within the home. Each person is registered with a general practitioner and the home has good working relationships with local surgeries. Community nurses support the people in the home as required and good records are in place when this has taken place. Medication is only administered by care staff who have received training in safe medication practices provided by the local community pharmacist: certificates were available as evidence of this. Two care staff administer medication is at all times. The medicines are taken directly from the container they have been dispensed in and put into named, lidded pots and then both staff take the medicines to each person. The staff confirmed that only medicines to be given at that time were prepared in this manner and none were prepared to be given later that day. This procedure it is known as secondary dispensing, as medicines are not taken individually from their packaging and given directly to each person. The owner explained that they had developed the system due to be layout of the building, the difficulty in moving a large medication trolley from room to room and the inability to take the trolley upstairs, as well as the unsuitability of taking the medicines in their packaging around the home. People who develop terminal illnesses whilst living at the home may remain if the district nursing service and the care staff can continue to be their needs. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Manor House are given a good level of support to be able to maintain contacts with family and friends. Meals are well cooked and suited to peoples needs. Evidence: Manor House is registered to accommodate only 16 people and this is one of the things people valued. The owner and her staff provide a home from home and look to avoid any institutional routines. People are spoken to each day about what they would like to do, either individually or with others, and staff facilitate activities such as card games, bingo, quizzes, and in better weather, use of the garden. The owners have two dogs as well as three ducks, and people said how much they enjoy these. Many of the people living at Manor House had lived in the area of the number of years and were pleased to be able to move to a home in an area they knew well and which allowed them to maintain contact with family and friends. People said were no rules that they have to comply with, for example getting up and going to bed, and people are free to leave the home for a walk if they wish, Care Homes for Older People Page 15 of 27 Evidence: accompanied by staff if necessary to their safety. Although the front door is fitted with a key pad lock, this is for the safety of anyone who would be unsafe to leave without a member of staff. The code to the lock is displayed for those people who do not require staff to accommpany them and they are free to come and go from home as they please. Staff said they always try to accommodate any wishes to go out. The menu at the home is traditional and very much enjoyed people. A cooked lunch and a cooked teatime meal are available each day, and should someone not like the main meal on offer, alternatives were always available. Snacks, fruit and hot and cold drinks are available throughout the day. The cook consulted with people regarding their meal preferences and these were noted and given consideration when planning menus. People are able to take their meals with others in the main dining room, the dining area in the first floor lounge, or their bedrooms, depending on their preference. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and their relatives can be assured that any concerns or complaints will be taken seriously and dealt with promptly. Evidence: The Commission for Social Care Inspection has received no complaints or concerns regarding Manor House since the previous inspection. The home has received one complaint, regarding the temperature of a bedroom. Mrs Broadhurst explained how this concern had been dealt with, such as monitoring the temperature within the room on an ongoing basis and if necessary considering an alternative heating source. People said they found the staff and the owners approachable and could talk to them easily about any issues: this was confirmed by the visitor spoken with as well. The owners formally ask people and their relatives about their views of the home and the most recent results from the questionnaires in October 2008 showed a high level of satisfaction. Regular resident and staff meetings allow people to comment about life in the home and contribute suggestions for improvement. Staff training records provided evidence that staff have received training in relation to abuse and the protection of vulnerable adults, and understood their responsibilities should they suspect someone was a risk. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Manor House provides a comfortable home to people. Evidence: Manor House is situated in a rural position just outside the village of St Cleer. It provides accommodation for up to 16 people and is domestic in scale, making it particularly suited to the needs of people with dementia, or a mental health need, who might find a larger or a more institutional service harder to cope with. The house was clean, tidy and maintained in good order. The home employs a housekeeper who has responsibility of maintaining the cleanliness of the home, and Mr Broadhurst undertakes much of the ongoing repairs and redecoration. Bedrooms were seen to be pleasantly decorated and personalised with items people had brought from home. Mr and Mrs Broadhurst, the owners continue to invest in improvements with the refurbishment and redecoration of the home and at the time of the visit a bedroom was being redecorated, re-carpeted and was being fitted with a new double glazed window. Due to the age of the property, one of the lounge rooms had a slightly damp odour and the owners were aware of this problem and explained their plans to improve the heating in this area. Care Homes for Older People Page 19 of 27 Evidence: Bedrooms are provided on both the ground floor and the first floor, and there is a stair lift providing access to the first-floor. There is ample communal space of the people living in the home offering a choice of where people would like to spend their time: there are two lounge rooms, a dining room and another small seating area in the front porch providing attractive views across the gardens, as well as a large lounge room with a dining table on the first floor. There was a bathroom on the first floor and a shower room on the ground floor, offering people a choice of a shower or bath. The bath was fitted with an electronic bath seat enabling easier movement in and out of the bath, and a shower seat was provided in the shower room. Mrs Broadhurst confirmed that the bathroom on the first floor was due for refurbishment. The laundry room and kitchen with found to be very clean and tidy indicating that regular cleaning occurs. Limited car parking is available in the grounds of the home. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Manor House has a good level of staffing and staff are well trained. Recruitment procedures ensure as far as possible only suitable people are employed. Evidence: People said that the staff were kind and caring and assisted them promptly when they needed help indicating that there were sufficient staff on duty. At the time of the inspection there were two members of staff on duty as well as the cook, housekeeper and Mr and Mrs Broadhurst. Two care staff were on duty in the evenings and one waking and one sleeping-in member of staff on call during the night. Mrs Broadhurst and the staff spoken to confirmed that the staff team was stable and very few vacancies arose: the last person to be employed at the home was employed over a year ago. The recruitment records for three care staff were looked at, including the one for the person most recently recruited. Each contained a completed application form, two written references and checks on whether the staff member had been referred to the Protection of Vulnerable Adults list or had any criminal convictions: all these documents had been obtained prior to the person starting work. This ensured as far as possible only suitable people were employed at the home. There was a record to show that each person who had started work at the home had Care Homes for Older People Page 21 of 27 Evidence: been provided with induction training with support from Mrs Broadhurst. Training certificates indicated that staff had recently received training in first aid, fire safety training, safe moving and handling, safe food hygiene practices, the Mental Capacity Act and the protection of vulnerable adults. The majority of the staff had either obtained or were in training for a NVQ qualification, a nationally recognised qualification in care. Discussions with Mrs Broadhurst and the staff team indicated that Mrs Broadhurst works alongside the staff team most days and meets with them, either individually or in groups, to identify their own training needs and to assess their work performance. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Manor House is well managed and the service is focused on the needs of the people who live in the home. Evidence: Mr and Mrs Broadhurst have owned Manor House for five years. Mrs Broadhurst manages the home on a day-to-day basis and Mr Broadhurst manages the day-to-day repairs and refurbishment of the home, as well as the accounts relating to the running of the business. Mrs Broadhurst has a NVQ qualification in Care at level 4 and the Registered Managers Award, both nationally recognised qualifications for which Mrs Broadhurst had to demonstrate her knowledge of the care needs of older people and her skills and competence in managing a care home. The home has a formal quality assurance system in which Mrs Broadhurst formally consults with the people living in the home and their relatives regarding their views on the quality of service provided. The most recent consultation took place in October Care Homes for Older People Page 23 of 27 Evidence: 2008 and the results demonstrated a high level of satisfaction. One relative said they were very happy with the care provided and another that the standard of care was excellent. From discussions with people and reviewing the comments made by their relatives, it was very clear that this is a service that is focused on the individuals who live in the house. Mr Broadhurst looks after money for several people living in the home: a sample of the records were examined and were found to accurately reflect the money held. Should people wish to have their money when Mr Broadhurst is not in the home, staff have access to petty cash to give them which can then be reimbursed at a later time: Mr Broadhurst prefers this arrangement as it reduces the number of people who have access to peoples money. Fire records were looked at during this inspection; these were up to date. Weekly checks and bi-annual servicing of the fire system show that it was well maintained in good working order. Staff had received regular training in what to do in the event of a fire and a fire risk assessment had been completed. Records were also available of the regular servicing of the stair lift, again to ensure this was maintaining good working order. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The registered providers should review each persons care plan to ensure it gives a more detailed description of the persons care needs and the action required by staff to meet those needs. The registered providers should keep under review the homes medication practices to ensure the risk of errors is minimised. 2 9 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!